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OFFICIAL DONATION. 



REPORT OF THE COMMISSION 



TO inquire: into the 



CONDITION OF THE INSANE 



WITHIN HOSPITALS 



STATE OF PENNSYLVANIA, 



COMMISSION APPOINTED BY CONCURRENT RESOLUTION 
OF THE SENATE AND HOUSE OF REPRESENTA- 
TIVES, APPROVED JULY 11, 1901. 



■ « « 






■> ; 



3 J t « 



WM. STANLEY RAY, 

STATE PRINTER OF PENNSYLVANIA. 
1902. 



.P37 



NOV 31 1303 
D. ofD. 




CONCURRENT RESOLUTION. 



No. 36. 



In the Senate, April 30, 1901. 

Whereas, The crowded condition of the hospitals for the insane 
gives warning of the early necessity of the accommodation of an in- 
creased number of patients, and the return of the insane from State 
institutions to those under control of the different counties is an ex- 
periment of doubtful expediency; and 

Whereas, It is demanded in the interest of ordinary humanity and 
for the credit of the Commonwealth that the care and treatment ot 
this unfortunate class of the community should be upon some es- 
tablished basis which shall afford them the most modern and ap- 
proved methods of treatment and the greatest amount of comfort 
and freedom compatible with their condition; and 

Whereas, The State of New York at the Willard Hospital has es- 
tablished a system whereby under kindly and gentle surveillance, 
the lunatics are found occupation for mind and body as successful 
artisans, tillers of the soil and mechanical constructors; therefore, 

Resolved (if the House concur), That a commission be appointed 
to inquire into the exact condition of the insane now in the State 
institutions and as to the policy and effect of the present practice 
of removing them to the different county institutions, as well as 
Aito the cost of the maintenance, and the policy and propriety of 
affording them light physical employment, to this end the commis- 
sion shall be authorized to have free and untrammeled admission 
to all State and county hospitals, and shall inquire into the most 
modern methods of treatment in vogue in reputable institutions of 
other States, and obtain the official views of experienced superin- 
tendents, physicians and officers as to any improved methods of 
government or economy. Especial attention shall also be directed 
to the physical condition of the buildings with regard to protection 
from fire and means of escape of their inmates. 

The commission shall be composed of three Senators, to be ap- 
pointed by the President pro tem.; four members of the House, to 
be appointed by the Speaker of the House; it shall serve without 
compensation, except for actual expenses and the cost of a secretary 
and stenographer; such expenses shall be paid by vouchers drawn 
upon the State Treasurer by the President of the Commission and 

(i) 



11 

filed and approved by the Auditor General. The President pro tei^. 
of the Senate, and the Speaker of the House shall be ex-officio mem- 
bers of the commission, which shall make a full report to be for- 
warded to each Senator and Member at least one month prior to the 
meeting of the next Legislature, such report to be forwarded in 
the proportion of thirty copies to each Senator, Member and heads 
of departments, and to embrace a draft of any proposed law which 
the Commission shall deem expedient to ameliorate the condition 
or protect the lives of the insane in this Commonwealth. 

E. W. SMILEY, 
Chief Clerk of the Senate. 
The foregoing resolution concurred in June 20, 1901. 

THOMAS H. GARVIN, 
Chief Clerk of the House of Representatives. 
Approved— The 11th day of July, A. D. 1901. 

WILLIAM A. STONE. 



REPORT OF THE COMMISSION APPOINTED BY CONCURRENT 
RESOLUTION OF THE SENATE AND HOUSE OF REPRE 
SENTATIVES, APPROVED JULY 11, 1901, TO INQUIRE INTO 
THE CONDITION OF THE INSANE WITHIN HOSPITALS OF 
THE STATE OF PENNSYLVANIA. 



To the Senate and House of Representatives of the Common wealth of 

Pennsylvania: 

Your Commission organized upon October 8, 1901, by the election 
of Hon. William P. Snyder as Chairman, and Alexander K. Pedrick 
as Secretary. 

From that date until the opening of the Legislature, the work of 
the Commission has been continuous. It has, as a body, visited the 
institutions herein named, upon the following dates: 

Philadelphia Hospital for Insane, May 17, 1902. 

Polk State Institution for Feeble-Minded, May 26, 1902. 

Warren State Institution, May 27, 1902. 

Willard State Hospital, New York, May 28, 1902. 

Manhattan State Hospital, Ward's Island, New York, June 28 1902. 

Norristown Insane Asylum, . July 12, 1902. 

Wernersville Asylum for Chronic Insane, July 26, 1902. 

Luzerne County Hospital, at Retreat, August 9, 1902. 

Wisconsin Board of Control, Madison, Sept. 8, 1902 

Dane County Asylum, Wisconsin, Sept. 9, 1902. 

Mendota State Asylum, Wisconsin, Sept. 9, 1902. 

Milwaukee Hospital for Insane, Sept. 10, 1902. 

W T awautosa County Hospital, Wisconsin, Sept. 10, 1902. 

Northern Hospital for Insane, Wisconsin, Sept. 11, 1902. 

Winnebago County Asylum, Oshkosk, Sept. 12, 1902. 

Chester County Hospital, Sept. 20, 1902. 

Matteawan Criminal Insane Hospital, Oct. 17, 1902. 

Lancaster County Hospital for Insane, Nov. 8, 1902. 

As supplementary to the labors of the main Commission, four sub- 
committees were appointed to take into consideration the various 
matters indicated in the Concurrent Resolution of the Legislature. 

(iii) 



IV 

The first sub-committee, consisting of Messrs. Bliss, Hail and Mar- 
shall, was directed to ascertain the physical conditions of the differ- 
ent institutions with regard to the escape of their inmates in case 
of fire. 

The second sub-committee, consisting of Messrs. Hall, Heidel- 
baugh and Sproul, was instructed to inquire into the policy and 
effect of the present practice of removing the insane to the different 
county institutions. 

The third sub-committee, consisting of Messrs. Sproul, Marshall 
and Anderson, investigated the policy and propriety of affording the 
insane light physical employment. 

The fourth sub-committee consisting of Messrs. Marshall, McClain 
and Scott, proceeded to obtain the official views of experienced super- 
intendents, physicians and officers as to any improved method of 
government and economy. 

In order that the labors of the Commission might attract the at- 
tention and invite the criticism of persons who were familiar with 
the management of the insane, public meetings were called and 
held in court room No. 646, in the City Hall, Philadelphia, on May 
6 and 7, 11)02. Invitations to attend these meetings were sent to 
the superintendents of every State and county institution in Penn- 
sylvania having in charge any insane patients. The opinions ol 
these officials were sought for and obtained and their testimony 
and their views are attached as part of this report. 

The examinations of the various sub-committees were carefully 
conducted. The one to which was assigned the duty of ascertain- 
ing whether the institutions had provided suitable means of escape 
in case of lire, was not merely satisfied with verbal statements 
from the superintendents, but required a formal and exhaustive 
statement as to the condition of each hospital. This statement 
will also be found attached to this report. 

The work of the other sub-committees, while not alluded to in 
detail, has been acted upon by the full Commission, and their con- 
clusions with regard to the various matters of inquiry will be at- 
tached hereto. 

One of the main questions at issue was the expediency of main- 
taining separate county institutions for the insane as against the 
general plan of accommodating them in large State institutions. 
In determining this question, the Commission decided to look into 
the practical workings of the county care system, as developed in 
the State of Wisconsin, a State which has become especially noted 
for its eneouragement of that system. In accordance with this plan, 
the Commission visited six of the insane asylums of Wisconsin, 
and examined their system of the care and treatment of the insane. 
The administration of the laws of that State is vested in a board 



of five members , which is known as the Board oi* "StaU Control of 
Wisconsin Reformatory, Charitable and Penal Institutions." Each 
member of the board is required to give his entire time to the 
duties of his office, and receives an annual salary of two thousand 
dollars and actual necessary expenses incurred in the discharge ot 
his duties. The board also employs a secretary, two clerks and a 
stenographer. It has power to act in the same manner as a com- 
missioner of lunacy, and can confine patients in any hospital or 
asylum in the State, and can order and compel the discharge of 
any patient they may deem sane (except persons held for criminal 
charges, or by an order of a judge of a court made in a criminal 
proceeding). The insane asylums are divided into two classes — one 
class designated as State institutions, in which the acute (or 
patients that have been insane less than two years) are confined. 
Those that have been insane for a longer period than two years 
are designated as chronic insane, and are confined (unless danger- 
ous) in county asylums, which are usually situated in close prox- 
imity to the county almshouses, but are under separate manage- 
ment. The State institutions are well managed, and in the matter 
of the care and treatment of the insane are second to none in the 
United States. The county asylums do not have the same comforts 
and conveniences for the patients as the State institutions, and the 
majority of them contain less than one hundred patients. Two 
of the board, ex-Judge W. P. Lyons and Gustav Kusterman, Esq., 
visited the asylums with the Pennsylvania Commission. These gen 
tlemen and their colleagues are exceptionally able and conscientious 
men, and amongst the foremost citizens of that State. 

In reaching the conclusions, after examining the Wisconsin hos- 
pitals, of both classes, your Commission realized that the danger 
of the county system was in the fact that less competent and 
conscientious men than those in charge at present might at some 
time become members of the Board of Control, and that the pa- 
tients confined in the county asylums, especially where the number 
was less than one hundred, might be allowed to drift back to the 
old condition which governed the almshouse management, which 
was in vogue fifty years ago. While the present control of the 
county asylums seems to be reasonably correct, there is always 
danger that their isolated condition, their small population, the 
absence of daily medical attendance might favor the neglect or 
abuse of patients. So far as the argument is used that proximity 
to home might benefit the patients who are sent to their local 
asylums, the result is an open question. The fact of being so near 
the place of their original residence, and yet being unable to live 
in it, is liable to be a source of irritation. When it is urged that 
the larger State institutions compel a patient to a certain degree 



VI 

to lose his individuality, it is no less true that in those larger in- 
stitutions the facilities for medical treatment, and for scientific 
care and attention are far better than in an isolated county hos- 
pital. There is a measure of safety in numbers, and the attend- 
ants of State institutions are much more likely to be trained for 
efficiency than those who are merely required to supervise a small 
number of patients. 

For these reasons your Commission cannot recommend the county 
system of the care of the insane unless the State should be divided 
into districts containing a sufficiently large population, so that the 
ratio of insane from this population would permit institutions to 
be maintained having an average of four hundred patients or more. 
It is possible that in this case the patients would obtain all the med- 
ical care, comforts and advantages of a State institution, and sub- 
ject to the doubt, as already expressed, might have the additional 
advantage, if any, of being in proximity to their relatives, so that 
they could be visited without much expense in traveling, or loss 
of time. • 

Another prominent point to which the attention of the Commis 
sion was directed was the advisability of supplying some light physi- 
cal employment to the inmates of insane asylums. In order to thor- 
oughly investigate this branch of the subject, it was deemed best 
to inquire into the laws of New York, and to visit a large insane 
asylum at Willard, in that State, an institution which has been prom- 
inently known for its methods of giving employment to the insane. 
An examination of the detailed report of this Commission (at- 
tached hereto), will give an idea of the methods of employment in 
use at that institution. It is needless to recite them in detail, 
but upon a farm embracing practically twelve hundred acres of 
land, and under rules which are flexible and adapted to the situa- 
tion, it is found that there is ample means of occupying more than 
fifty per cent, of the able-bodied patients. They work in the fields, 
vineyards, berry patches, in the shops and at almost any occupation, 
except, perhaps, carpentry work. They manufacture the brooms, 
brushes, baskets, mattresses, clothing, boots and shoes. They have 
out-door work upon the quarries and roads. To summarize this 
point, the Commission recommend, in brief, that occupation of some 
sort, steady, and, if possible, outdoor, should be provided for such 
inmates as are physically and mentally able to do the same. At- 
tached, however, to this recommendation, is the proviso, that at no 
time and under no circumstances, should the patient be regarded as 
a money-making machine. He should still retain his position as 
purely an object of care and solicitude, and no work should be as- 
signed to him which would not be beneficial in its results. The 
question of cost or compensation should never enter into this phase 



Vll 

of his existence, because the State could never afford to degrade the 
objects of her care and charity to the mere level of agents to make 
money. It may be added that the general theory of employment, 
as we have indicated, is not by any means a novel one in Pennsyl- 
vania, inasmuch as a number of our State and several county insti- 
tutions are acting upon this well-established theory. The object 
of the Commission is to recommend its more general extension. 

Your Commission enters with some hesitation upon a branch of 
the subject which has been forced upon them by prevailing condi- 
tions, and that is the control and investigation of the State and 
county hospitals for the insane by representative State officials. 
There are seven large State institutions, and eighteen county hos- 
pitals. The State institutions, at the time of our examination, con- 
tained 6,700 actual insane persons, while the county institutions 
contained 3,928, making an aggregate of 10,628 insane persons to 
be cared for. 

Of the State institutions it may be said that the Commission, as 
a rule, found them governed by gentlemen of long experience, and 
with an appreciation of the difficulties of their task and a disposi- 
tion to protect and benefit the inmates under their care, but the 
Commission realized at an early stage of the inquiry that there 
was a lack of uniformity in the management of these institutions. 
The Commonwealth has been remiss in not framing any general 
system of laws for their uniform government, and the will and 
dictum of each separate board of trustees or managers constitutes 
the law of each asylum. There are separate systems of obtaining 
supplies — separate rules for the daily routine of the institutions — 
separate methods of caring for particular classes of inmates; in 
short, a lack of any general or coherent plan for the management 
and government of the seven asylums upon any uniform basis. 
This defect was brought still more vividly to the front when the 
laws of the State of New York were compared with those of Penn- 
sylvania. 

The Commission then sought to find under the enactments pro- 
viding for the Board of Public Charities and for a Lunacy Com- 
mission, whether a remedy could not be supplied, but the result was 
entirely unsatisfactory. The Board of Public Charities and the 
Lunacy Commission, while entrusted with authority in certain spe- 
cific cases, appeared to be merely "advisory" committees rather than 
agencies representing the power and control of a great Common- 
wealth over her insane institutions. Composed, as they are. of 
gentlemen of high character, and efficient and fully qualified to per- 
form the comparatively minor and unimportant duties, and to exer- 
cise the comparatively slight powers conferred upon them by the 
present laws, they, nevertheless, convey no impress of the strong 



Vlll 

hand of authority. The majority of their members visit thu institu- 
tions very seldom, but entrust the more active and intricate exam- 
inations to two paid agents. Upon these two paid agents prac- 
tically has rested the examination of all the State and county insti- 
tutions, in addition to the prisons and other hospitals. However 
faithful these agents may have been, however intelligent their in- 
quiry, it is apparent to your Commission that they must necessarily 
prove entirely inadequate to meet the demands of existing condi- 
tions. No two men are in themselves properly able to investigate 
the necessities of 10,628 lunatics, and 1,117 feeble-minded people. 
The task is beyond them. Neither is it probable that the members 
of the Board of Public Charities can, in the intervals from other 
business, find time to devote themselves with much energy or zeal 
to the numerous questions which arise as to the government of 
the insane asylums. They receive no salary, and cannot be ex- 
pected to become the active, energetic officials which the Common- 
wealth needs to protect the weak, infirm and helpless inmates of 
her asylums. As a matter of fact, during the year 1900, the report 
of the Board of Public Charities, when analyzed, sets forth that of 
the ten members of the Board, only two visited any of the State 
hospitals for the insane, and they visited but two, those at Polk 
and Warren. The General Agent made one visit during the year 
to each of the institutions at Harrisburg, Norristown, Dixmont, 
Warren, Polk and Wernersville, and two to Danville. There is no 
record as to any visits paid by the members of the Committee on 
Lunacy during that year. 

The report of the Board of Public Charities shows that during 
the year 1901, of the ten members of the State Board, only one 
visited any 'State insane asylum, and he but three of them. There 
is no record of the Hospital at Wernersville having been visited 
at all by any members of the State Board, or by its General Agent 
during the entire year. The General Agent's record appears to 
be, during 1901, that he made one trip each to the institutions at 
Danville, Norristown, Dixmont, Warren and Polk, and two trips 
to the Harrisburg Insane Asylum. As the above figures are taken 
directly from the official reports of the Board of Public Charities, 
they presumably represent correctly the official attention which 
the great Commonwealth of Pennsylvania, through her official 
agents, has taken in visiting the eleven thousand unfortunates for 
whom she is responsible. These facts are simply illustrative of the 
inefficiency of existing laws. 

Your Commission has no desire in any way to depreciate the earn- 
estness or faithfulness of the local trustees or managers who con- 
trol the various State institutions, nor is it any part of our duty to 
criticize the actions of such trustees or managers, but while they 



ix 

may fairly be assumed to have attended to their duties, they cannot 
be said to be strictly Governing Representatives of the Common- 
wealth, their authority being confined to separate institutions, and 
it is this central official government alone with which the Commis- 
sion is at present dealing. 

Confronted by this condition of affairs, your Commission endeav- 
ored to ascertain whether the laws of any other State of the Union 
offered any suggestions which could be adopted with advantage in 
Pennsylvania. They found that the State of New York had made 
approaches towards a better system by the establishment of an 
official commission, termed a "State Commission in Lunacy." This 
consists of three commissioners, one a reputable physician, who must 
be a graduate of an incorporated medical college, of at least ten 
years' practical experience (and who has had five years' experi- 
ence in the treatment of mental and nervous diseases), and another 
a reputable attorney, of not less than ten years' standing. The 
third commissioner must be a reputable citizen. Each of these offi- 
cials receives an annual salary of five thousand dollars, together 
with twelve hundred dollars each in lieu of traveling and incidental 
expenses. These commissioners are appointed by the Governor, 
by and with the advice and consent of the Senate, and their term 
of office is for six years. They are charged with the execution of 
all laws relating to the custody, care and treatment of the insane, 
and are required to examine all institutions which contain insane 
patients. They are entitled to free access to all grounds, buildings, 
books and papers of any such institution, and may appoint special 
agents to examine all books, papers and accounts relating to the 
insane. It is their province to ascertain the fitness of all officers, 
attendants and employes, and to visit all institutions personally. 
They also meet the local managers of the respective institutions in 
conference, and consider in detail all questions of management and 
improvement of the several institutions. They are empowered to 
make proper regulations in regard to the correspondence of the in- 
sane. Their reports to the Legislature include estimates of the 
amounts required for the use of the State hospitals. They also have 
power to purchase or contract for supplies, and their orders assign 
to each institution such number of patients as they may determine. 
The State is divided into hospital districts, with such sub-divi- 
sions as the Commission may deem expedient. 

In order to perfect the control by the Commission of the several 
State institutions, it is required to keep in its office, accessible only 
to the Commissioners ,their secretary and clerk, a full report, show- 
ing the name, residence, sex, age, nativity, occupation, condition and 
date of commitment of every insane patient within the State, to- 
gether with all other data relating to his or her particular cas^. 



This Commission has also power, after a civil service examination, 
to appoint a director of the pathological institute, who shall perform 
such duties with regard to pathological research as may be required 
by all the State hospitals for the insane. They also appoint an at- 
torney for each State hospital to conduct its legal business. The 
general powers and duties of the local board of managers are made 
subject to the statutory powers of the Commission. 

The dominant idea of the New York system is the centralization 
of power in hands which are competent to effect certain definite re- 
sults. First, central control of the institutions. Second, Civil ser- 
vice procedure with regard to the appointment of all employes. 
Third, A general supervision over all matters affecting the manage- 
ment of the several institutions. 

Conceding the weakness of the present system of management in 
Pennsylvania, owing to the inefficiency of existing laws, your Com- 
mittee recommend the adoption of the New York plan. They have, 
in accordance with this idea, formulated a bill for presentation to 
the Legislature. In the proposed act of Assembly, the principle has 
simply been embodied of having a central board of authority, com- 
posed of active and energetic Commissioners under a stipulated sal- 
ary, and having absolute control of the insane in Pennsylvania, who 
shall be responsible for their care, maintenance and treatment. These 
paid Commissioners devoting their entire time and attention to the 
care of the insane, are not likely to be neglectful of their duties, nor to 
allow their private business to interfere with the duties which they 
owe to the helpless wards of the State. 

It has been brought very forcibly to the attention of your Com- 
mission that the Commonwealth is delinquent in several respects, 
besides those of management, in regard to its insane. Upon no 
sound principle of equity or fair treatment, can the association of 
convicts and criminal insane be tolerated among the innocent pa- 
tients. Some of those thus thrown in contact with the harmless 
insane are murderers, committed by the courts, or sent from the jails 
or penitentiaries. It is needless to expatiate upon these facts. The 
lunatic is entitled even more than the sane person, to protection from 
the brutal instincts of the criminal classes. In many cases the hos- 
pitals in which the convicts and criminal insane are thus immured, 
are utterly unfit for the purpose of confinement of criminals. The 
average insane hospital in Pennsylvania has never been designed 
for the convict and criminal insane patients. Apart from all ques- 
tions of finance or economy, there is, in the judgment of your Com- 
mission, an absolute necessity for the establishment of a hospital 
especially designed and arranged for the care and treatment of the 
criminal insane. 



XI 

Equally necessary is the establishment of hospitals for feeble- 
minded and epileptic patients. There are, at Polk, 755 patients of 
this class, and at Elwyn, a private institution, 1,003, making a total 
of 1,758 already provided for, but it appears by the reports of the 
Eleventh Census of the United States, which gives the number of 
feeble-minded by states and territories, that as far back as the 
year 1890, there were in the State of Pennsylvania 8,753 of this un- 
fortunate class. Twelve years have elapsed since that census, and 
it is fair to assume that there has been a large increase in that 
number. These unfortunate need the protecting care of the State, 
and your Commission calls attention to this fact in the same manner 
as it has done in the case of the criminal insane. It is a question 
for the Legislature to consider whether the Commonwealth shall 
establish such institutions for the protection of her unfortunates, 
or whether a close and niggardly regard for economy shall debar 
them from the care and attention to which they are entitled. 

The crowded condition of the existing insane hospitals in Penn- 
sylvania demands immediate attention. An act has been passed 
for the construction of an additional hospital for the insane to be 
conducted under the homoeopathic medical system, and this, when 
completed, may afford some relief to the existing institutions, but 
not sufficient to accomplish the purpose. The overcrowded conditio a 
at Norristown and other hospitals, as shown by the testimony, should 
compel prompt attention by the Legislature. It is our belief that 
upon the inauguration of the proposed new system of control, the 
incoming Commission should re-adjust the entire hospital system 
in the State, so as to classify the institutions and their inmates, and 
to recommend the establishment of new State institutions at such 
central points as might be deemed beneficial. While greater facili- 
ties are immediately demanded, it is nevertheless true that the entire 
system should be governed by some general plan to be designed 
and carried out by the central Commissioners. 

The pleas of humanity cannot be disregarded, and your Commis- 
sion, urges with all the earnestness with which it is capable, some 
immediate action to relieve the overcrowded condition of the ex- 
isting hospitals. They believe this action can be best supervised 
by the suggested Commission to take entire supervision of the whole 
subject. 

Supplemental to the conclusions which were reached by your Com- 
mission on the above points, it has been suggested by eminent medi- 
cal authority that there should be established at certain central 
points hospitals for temporary detention, to be used for determining 
the condition and needs of the insane prior to their final commit- 
ment to such institution as seems to be suited to the requirements 
of the case. These institutions would practically mean separn+p 



XH 

places for the curables. It would, as has been suggested, not fasten 
upon the individuals who are temporary patients, the stigma of 
having been in an insane asylum, and might bring about a greater 
number of cures than if the patients, without much preliminary 
effort, were summarily immured in one of the regular asylums. 

Respectfully submitted, 

JOHN M. SCOTT, 
WILLIAM C. SPROUL, 
MILTON HEIDELBAUGH, 
Committee on the part of the Senate. 

WARD R. BLISS, 
FRANK B. McCLAIN, 
DAVID M. ANDERSON, 
HENRY HALL, 
WILLIAM T. MARSHALL, 
Committee on the part of the House of Representatives. 

WILLIAM P. SNYDER, 

President of Commission. 

ALEXANDER K. PEDRICK, 

Secretary. 



LEGISLATIVE COMMISSION TO INQUIRE INTO THE CONDITION 
OF PENNSYLVANIA INSANE. 



REPORT 



OF THE 



SUB-COMMITTEE 



TO 



INQUIRE INTO THE PHYSICAL CONDITION OF BUILDINGS 

OCCUPIED BY THE INSANE, WITH REGARD 

TO PROTECTION FROM FIRE. 



WARD R. BLISS, Chairman, 
HENRY HALL, 
WILLIAM T. MARSHALL. 



(i) 




(2) 



KEPOKT OF THE SUB COMMITTEE APPOINTED TO INQUIRE 
INTO THE PHYSICAL CONDITION OF BUILDINGS NOW OC- 
CUPIED BY THE STATE INSANE, WITH REGARD TO PRO- 
TECTION FROM FIRE. 



To the Legislative Commission to Investigate the Condition of Penn- 
sylvania Insane: 

Gentlemen: At a meeting held on October 8, 1901, of the joint 
Commission to Investigate the Condition of the Pennsylvania In- 
sane, the following resolution, which was offered by Ward R. Bliss, 
was adopted: 

"Resolved, That a special Committee of three be appointed, whose 
duty it shall be to make immediate inquiry of the officials in control of 
the various institutions, as to the physical condition of the buildings 
under their control, now occupied by the State insane, with regard 
to protection from fire, and the means of escape of their inmates, 
this report to be obtained and submitted to the Commission at as 
early a date as possible." 

In accordance with the foregoing resolution the undersigned be- 
ing the sub-committee which was appointed to inquire into the phy- 
sical condition of the buildings now occupied by the State insane, 
with regard to protection from fire, beg leave to submit the follow- 
ing report: 

They have made an official inquiry of the seven institutions which 
are absolutely controlled by the State for the accommodation of 
the insane, and of the nineteen institutions in the different counties 
to whom insane persons have been sent for care and treatment. 

Wliile it would be possible for the sub-committee to analyze the 
different replies which have been made by the respective institu- 
tions, it has been thought best to present the report from each insti- 
tution in full. By this means the Commission will be enabled to 
form its own judgment as to the condition of the various buildings, 
and the matter is of such importance that it is desirable that no de- 
tail, however slight, shall be overlooked. 



The sub-committee, therefore, presents in extenso the detailed re- 
ports from each institution. 

Respectfully submitted, 

WARD R. BLISS, 
Chairman of Sub-Committee, 
HENRY HALL, 
WM. T. MARSHALL. 



PENNSYLVANIA STATE LUNATIC HOSPITAL FOR INSANE, 

HARRISBURC, PA. 



Office of the Superintendent, 
Harrisburg, Pa., November 2, 1901. 

Sub-Committee of the Legislative Commission to Investigate the 
Condition of Pennsylvania Insane: 

Gentlemen: I enclose, herewith, answers to the queries received 
by me on Sunday the 27th ult., and would add that the first group of 
buildings referred to in our report is four stories in height. These 
buildings, on account of their being fire traps, have been repeatedly 
condemned; on this account two years ago, all the patients were re- 
moved from the third and fourth stories and congregated in the 
first and second stories, thus reducing the risk of danger by fire to a 
minimum. Under the present conditions, I do not see how the risk 
from fire could be in any way diminished. We have watchmen on 
every floor both day and night, and use every precaution to protect 
our inmates. A portion of these buildings will be demolished during 
the coming year. 

Very truly yours, 

H. L. ORTH, 
Superintendent. 



1. What number of insane inmates are in your care? 883. 

2. Males? 442. 

3. Females? 441. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 100 attendants; ca- 
pacity of our buildings for care of patients, 720. 

Note by Secretary of Commission. — This letter was written prior to the reception of bids in 
December, 1901, for new domitories, kitchens and various other additions to the asyluna. 



19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? No; the boilers are located in 
a separate building 75 feet from the nearest wards. 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? By electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? We own and operate our electric plant; the lights 
in the wards are controlled by switches under lock and key. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes, one general watchman 
and fourteen watchmen who have the care of the patients during 
the night. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? The 
nearest fire engine belongs to the city of Harrisburg, and is three- 
fourths of a mile from our plant; it is accessible by direct telephone 
to the mayor's office; the buildings are surrounded with fire plugs 
planted by the hospital and are supplied with union connections the 
same size as in the city of Harrisburg; we have our own hose car- 
riage with 500 feet of hose. 

28. Have you telephone communication with any located fire ap- 
paratus? By telephone connection with the mayor's office. 

29. Have you established rules in case of an alarm of fire, or in 
case of alarm, have you any organized or printed methods to pur- 
sue? If you have, please send copy of them? Yes, the following 
general directions are given to all employes: "Notify the superin- 
tendent at once, uncoil the hose and turn the water on the fire; the 
engineer and his assistants, as soon as alarmed, to run to the plug 
nearest to the fire with the hose carriage, attach the hose and make 
ready to turn on the water; the patients in the meanwhile, to be 
removed from the burning building. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? No; nothing nearer than 600 feet. 



STATE HOSPITAL FOR THE INSANE, WARREN, PA. 

1. What number of insane inmates are in your care? 1022 on 
October 29, 1901. 

2. Males? 516. 

3. Females? 506. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? (1) Number of at- 
tendants varies from 100 to 120. (2) 600 in main building, 135 in 
buildings now being furnished. 

5. Are there any violent cases which require separate confine- 
ment? Yes, usually from 15 to 20. 

6. Of what are your buildings constructed — frame, stone or brick? 
Main building is stone, with floors and walls of brick, iron and 
cement; two two-story annexes are brick; one convalescent ward 
in two-story frame building. 

7. What is the width of the staircases connecting your different 
stories? Two 5 feet 11 inches wide; eight small ones — six 4 feet wide 
and two 4 feet 6 inches wide. 

8. Are there front and back, or only single staircases? Each 
ward opens on two staircases; two-story buildings have two stair- 
cases. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) In main building 195 on first floor, 192 
on second floor, 190 on third floor, 39 on fourth; remainder of patients 
sleep in corridors and dormitories. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 39 feet 5 inches above water table. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? No; 
stairways are constructed of slate laid upon iron beams with walls of 
solid masonry; in two-story brick annexes stairways are of iron. 

12. What is the size of the doors and windows opening from the in- 
terior into the fire escapes? All doors into staircases are 2 feet 10 
inches wide. 

13. How near do these fire escapes approach the ground? . 

14. Whence do you draw your water supply? From driven wells 
pumped into two large reservoirs. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? All of 
them. See addenda. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) See addenda. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? See addenda. 



8 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? By steam; boilers are in separate 
buildings. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? No! No!! They are in laundry 
building some distance from main building. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sitions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Illuminating gas. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? It is regulated by attendants in each ward. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes, eighteen on duty from 
9.30 P. m! to 5.30 A. M. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? In War- 
ren, two and one-half miles away; public ones. 

28. Have you telephone communication with any located fire ap- 
paratus? Buildings are all connected with each other by telephone; 
main building is connected with fire department in Warren. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. No. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? No. 

MORRIS S. GUTH, M. D., 
Superintendent State Hospital for the Insane, Warren, Pa. 
October 29, 1901. 



Answers to Questions 15, 16 and 17. 

Amount of Hose. 

One hundred and fifty feet of one and a half inch hose in each ward 
on first, second and third floors in the dust closets at the center of the 
wards connected to a one and one-half inch stand pipe filled at all 
times and ready for use, making a total of 2,700 feet of one and one- 
half inch hose. 



One hundred and fifty feet of one inch hose in each ward on the 
fourth floor — four wards in all located at the lavatories and con 
nected to a. one inch stand pipe, making GOO feet on fourth floor of one 
inch hose. 

One hundred and fifty feet of one inch hose in the amusement room 
connected to a one inch stand pipe located near the stage. 

One hundred and fifty feet one inch hose in the attic over amuse- 
ment room and chapel connected to a one inch stand pipe. 

There are six one and one-half inch steam line® running to the differ- 
ent attics. One line to each wing over the wards, and they are con- 
nected with the high pressure boilers, these lines have a double out- 
let which will at any time flood the entire attic with steam. The 
valves are under the control of the engineer or fireman. 

There is 150 feet of one and one-quarter inch hose located in the 
wash room of the laundry building, which can be connected to several 
different plugs around the building as the case may require. 

There is 150 feet of one and one-quarter inch hose at the coach 
barn which is located just inside the main entrance door with a two 
inch plug across the road in front. 

There is 600 feet of two inch hose at the stock barn located in three 
places with 200 feet in each, one at the front of barn, one at the rear 
north end and one at the rear south end and have a three inch main 
water supply with pressure of 60 pounds. There are two heavy 
strong ladders located at the north and south wings of the barn and 
available from the outside. 

There is a water column one and one-half inches running from the 
boiler house pump and also one and one-half inch steam lines from the 
boiler to be used in case of fire in or over the carpenter shop. 

At Hygeia Hall there is 300 feet of one and one-half inch hose di- 
vided in two sections and located at the front and rear of the build- 
ing and connected with a one and half inch main with water pressure 
of 55 pounds and can be increased in case of fire with the main pump. 

At the water works 150 feet of one and one-quarter inch hose 
connected to the main pumping line which will reach any part of the 
building or the farm house adjoining. 

At the Farm Colony, 300 feet of one and one-quarter inch hose is 
divided in two sections and located in hose houses at front and rear 
of the buildings and the attachment is to a two inch main line with 
pressure of over 50 pounds, which can be increased with pumps. 

All outlets for the water supply valves and faucets are three-fourth 
inch in the wards and elsewhere. 

At each bay window is a water connection for one inch hose in 
front and three-fourth inch in the rear of the building with 400 feet 
of one inch hose on reels with wheels which can be conveyed quickly 



10 

wherever needed, and 200 feet of three-fourth inch hose for the out- 
lets in the rear. 

Summary of Hose in and Outside of Buildings. 

Three-fourth inch, 200 feet. 

One inch, 1,300 feet. 

One and one-quarter inch, 750 feet. 

One and one-half inch, 3,000 feet 

Two inch, 600 feet. 

Total, 5,850 feet. 



MOREIS S. GTJTH, M. D., 
Superintendent Hospital for the Insane, Warren, Pa. 
October 29, 1901. 



STATE INSTITUTION FOR FEEBLE-MINDED OF WESTERN 
PENNSYLVANIA, POLK, PA. 



Polk, Pa., October 28, 1901. 

Sub-Committee of the Legislative Commission to Investigate .the 
Condition of the Pennsylvania Insane, 

No. 1510 Chestnut Street, Philadelphia, Pa.: 

Gentlemen: In accord with yours of the 26th instant, I herewith 
return answers to your interrogatories, and the following in regard 
to your request for suggestions and recommendations which might 
improve the condition of our buildings and add to the safety of its 
inmates. 

Our greatest danger from fire is the over-crowded condition of our 
dormitories, which makes it necessary for large numbers of helpless 
paralytics to occupy dormitories on the second floor. The stairways 
being narrow, it is with difficulty that they are carried up and down 
stairs, which difficulty would, of course, be aggravated in case of 
fire. Our buildings, while admirable for the care of the higher 
grades of the feeble-minded (those who in a measure can care for 



11 

themselves), are totally lacking in the proper facilites for caring 
for the helpless and untidy paralytics, the most difficult of all the 
defective classes to care for, and for whom we have no proper facili- 
ties. The safety of our inmates demands that we be provided 
with custodial buildings specially constructed for the care of this 
most unfortunate class. I most earnestly solicit the aid of your 
honorable committee in obtaining an appropriation to provide cus- 
todial buildings for our institution at the next session of the State 
Legislature. 

Very respectfully, 

J. M. MUEDOCH, 
Superintendent. 

1. What number of insane inmates are in your care? 754 insane 
and feeble-minded. 

2. Males? 430. 

3. Females? 324. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 50 attendants. Ac- 
tual capacity 600. 

5. Are there any violent cases which require separate confine- 
ment? Yes. 

6. Of what are your buildings constructed, — frame, stone or brick? 
Brick. 

7. What is the width of the staircases connecting your different 

stories? 3 feet. 

8. Are there front and back, or only single staircases? Front and 
back. 

9. Upon what floor or story are there sleeping roioms? (State the 
number on each floor). 1G sleeping rooms, containing 100 inmates, 
on first floor; 48 sleeping rooms, containing 654 inmates, on second 
floor. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 16 feet. 

11. Have you any outside fire escapes? If so, what stories do 
they reach, and how is access obtained to them from each floor? No. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? 

13. How near do these fire escapes approach the ground? 

14. Whence do you draw your water supply? From springs about 
two miles distant; water collected in reservoir of 945,000 gal. ca- 
pacity, situated on a hill one-half mile from institution and at an 
elevation of 131 feet above floor level. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? All stories 



L2 

reached by water supply. 160 one-half inch vents on first floor, 
160 one-half inch vents on second floor, also 32 bath tubs on second 
floor. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe)? Yes. 17 two inch 
connections. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 1,700 feet of two inch hose in 100 
foot sections, on first floor. Hose reaching second floor. Fire buck- 
ets are kept full in bath rooms on second floor. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Heated by steam, also gas fires 
protected by guards. Boilers not accessible to the insane. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? Boilers in power house 200 
feet in rear of main buildings. No boilers within main buildings. 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? Natural gas 
fires protected by locked heavy wire guards. Insane have no access 
to them. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Fixed rules. Lights can only be turned on or off by 
attendants, who alone carry keys to the key switches turning on or 
off lights. 

23. Ho the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes. Three all night. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Six 
miles. Not accessible in an emergency. 

28. Have you telephone communication with any located fire ap- 
paratus? Have telephone connections to Franklin, six miles away. 

29. Have you any established rules in case of an alarm of fire, 
or have you any organized or printed methods to pursue in case of 
alarm? If you have please send copy of them. Yes. See en- 
closure. This is supplemented by lectures and drill. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? No. 



13 

General Rules to Employes in Regard to Protection against Fire. 

1. Make yourself conversant with the location and manner of 
using the fire hose placed in the bath rooms and corridors. 

2. No matches but the ones furnished by the Institution shall be 
brought on the premises. Use every means possible to prevent in- 
mates getting possession of matches. 

3. In case of fire, keep cool, do not cry "fire!" Notify Superin- 
tendent at once by messenger while you use woolen blankets and 
water to extinguish the fire. 

Keep communicating doors and windows closed. 
Remove children to a place of safety. 

Oct. 28, 1901. J. M. MURDOCH, M. D., 

Superintendent. 



STATE HOSPITAL FOR THE INSANE, DANVILLE, PA. 



1. What number of insane inmates are in your care? Novem- 
ber 1st, 998. 

2. Males? 519. 

3. Females? 479. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 118 — percentage 1 
to 8.16 patients. Employes, 95 — percentage 1 to 4.52 patients. 450 
males; 350 females — 800, total, including annex. 

5. Are there any violent cases which require separate confine- 
ment? Occasionally. 

6. Of what are your buildings constructed — frame, stone or brick? 
Stone and brick. 

7. What is the width of the staircases connecting your different 
stories? Centre stairs (double) connecting with wards, four feet 
six inches, slate; ward stairs three feet nine inches, iron and slate, 
fireproof. 

8. Are there front and back, or only single staircases? Ward 
stairs single. Two opening front of building. Six in the rear. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor). Four stories: Ground 237, 2d 251, 3d 251, 
4th 156. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? Approximately, 48 feet. 

11, Have you any outside fire escapes? If so, what stories do they 



14 

reach, and how is access obtained to them from each floor? No. 
Inside stairways at each end of all wards of iron and slate. Several 
of these stairways passed through the fire of 1881 uninjured and 
are still in use. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? ■ 

13. How near do these fire escapes approach the ground? 

14. Whence do you draw your water supply? Pumped from Sus- 
quehanna river to reservoirs (capacity one and one-half million gal- 
lons, estimated) in rear of building. 

15. W T hat stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? In the 
centre of each wing (ward) is a 2-inch stand-pipe with outlet for 1J 
inch hose, 150 feet each. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe)? Answered under 
No. 15. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? In each ward 150 feet 1J inch hose; 
50 gal. chemical engine with 50 feet inch hose on fourth story that 
will be available anywhere upon this story; entire length of building. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Indirect steam radiators from 
central boiler house for main building. Annex for males heated by 
two low pressure cast iron boilers, "0. K. Smith" and "Model" placed 
in fireproof rooms in basement. In neither case are they accessible 
to patients. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? No boilers for heating pur- 
poses in main building. Two in annex. Boilers for heating main 
building in separate building, engine house. 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Illuminating gas, with Welsbach light. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Yes, under control of ward attendants, gas being 
lighted and extinguished by fixed rules. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No, except at burner. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many and between what hours? Watchman and watch woman 
make regular rounds of building from nine A. M. until relieved by 



15 

day ni s, five A. M. No intermission between day and night ser- 
vice. Night nurses on duty in various parts of building. Annex 
night watchman in each ward. 

25. Do you allow smoking in the dormitories? Smoking is not 
allowed in any part of building occupied by insane. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Dan- 
ville, one mile away. There is a regulation fire plug connected with 
6-inch main, to which the force of the pump can be applied directly 
in front and rear of each section of main building, 14 in all. 

Four reels regulation fire hose (2-J inches), 200 feet each, situated 
in basement, accessible from outside, and three reels on carriages, 
200 feet each, kept outside of building. A 60 gal. Steinfel chemical 
engine, 300 feet hose, in basement of executive department (centre). 

28. Have you telephone communication with any located fire ap- 
paratus? Nothing except the regular telephone service. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. Fire department or- 
ganized from resident employes. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance and what is 
their character? None near. Nearest about 350 feet from wards, 
are the stable, ice house and laundry. 

Two dust flues extending from fourth story to basement in oldest 
part of building are studded off, and lathed and plastered from a gen- 
eral closet; this wooden partition offering a great menance in case of 
fire. Should be constructed wholly of brick. Three fast elevators 
built in same way were recently made fireproof. 



STATE HOSPITAL FOE THE INSANE, NORKISTOWN, PA. 



Male Department. 

1. What number of insane inmates are in your care? 1,101. 

2. Males? 1,101. 

3. Females? None. 

4. How many attendants have you for the insane inmates, aud 
what is the actual capacity of your buildings? One attendant to 
every ten patients. Capacity, 850. 



16 

5. Are there any violent cases which require separate confine- 
ment? Yes, five. 

6. Of what are your buildings constructed — frame, stone or brick? 
Stone and brick. 

7. What is the width of the staircases connecting your different 
stories? 4 feet 10 inches. 

8. Are there front and back, or only single staircases? The 
staircases are at the ends and in the centre of the buildings. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor). 26 rooms, two large and one small dormi- 
tories on each floor. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 18 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? There 
are no outside fire escapes. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Doors, 2 ft. 9 in. x 7 ft. 6 in. No win- 
dows open into the fire escapes. 

13. How near do these fire escapes approach the ground? They 
lead to the ground. 

14. Whence do you draw your water supply? From a reservoir on 
the hospital grounds. 

15. What stories of your building are reached by w&tc? supply? 
What are the number and size of vents upon each floor? All of 
them. One vent on each floor, three inches in diameter. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe)? There are hose 
attachments on all floors, one on each, three-quarter inch nozzle. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 300 feet. 2-inch hose, three-quar- 
ter inch nozzle. 50-foot sections. Attached ready for use. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Heated by steam. Boilers not 
accessible to the insane. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? No. They are in a boiler house, 
which is not connected with the hospital buildings. 

20. Are there any anthracite or bituminous stoves or grates in 
position where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electricity. 

22. Is the lighting controlled by fixed rules, or bow is it governed 
and regulated? By fixed rules, 



17 

23. D.o the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many and between what hours? 19 night watchmen, on duty 
from 9 P. M. to 6.30 A. M. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in any emergency? Five 
companies less than a mile distant. All accessible in an emergency. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. Yes. Copy en- 
closed. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance and what is 
their character? None. 



The buildings at the State Hospital at Norristown are in good 
physical condition. Each section has its own hose, which can throw 
water to the most distant point of the building. Each of the build- 
ings has means of escape in the centre and at both ends — the es- 
capes are within the buildings, the end ones being constructed of 
iron and slate, the middle one is a wooden stairway. 

If the wooden stairways were replaced by iron and slate, it would 
add to the security and efficiency of the escapes. 
Very respectfully submitted, 

D. D. RICHARDSON. 



Female Department. 

1. What number of insane inmates are in your care? 1,146 on 
November 25, 1901. 

2. Males? 

3. Females? 1,146 on November 25, 1901. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 117 attendants, 135 
employes. 

5. Are there any violent cases which require separate confine- 
ment? Three, with others occasionally. 

2 



18 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick, with the exception of Stinson cottage, which is part frame. 

7. *What is the width of the staircases connecting your different 
stories? 4 ft. 10 in. 

8. *Are there front and back, or only single staircases? Front 
and back staircases are fireproof, centre is wood. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor). First and second 28 rooms and 2 dormitories 
on each floor of sections 1, 2, 3, 4. Two dormitories first floor in 
section 10. Two dormitories each floor section 12. One dormitory 
each floor Stinson cottage. 

10. *What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? About 18 feet. 

11. *Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Stinson 
cottage has none. Lower Farm cottage second and third. Through 
window 2 ft. x 4J ft. x 3 ft. 10 in. 

12. *What is the size of the doors and windows opening from the 
interior into the fire escapes? Doors 2 ft. 9 in. x 7 ft. 6 in. No win- 
dows. 

13. How near do these fire escapes approach the ground? Go to 
ground. Lead into fireproof corridor which connects the different 
wards. Exit also on top of different corridors, having slate steps 
to ground. 

14. Whence do you draw your water supply? Our own reservoir 
and Norristown. 

15. *What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? All of them. 
Number varies from 4 to 12. About one inch. Have vents for hose 
additional — one on each floor and one in the attic. 

16. *Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe)? All floors ex- 
cept at Stinson cottage. Hose L§ inches. Nozzle opening f inch. 

17. *How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 300 feet on a reel on each floor. 
Hose 1J inches. Also have 12 buckets filled with water always ready 
on each floor and in attic. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Steam. Not accessible. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? Boilers not connected with pa- 
tients' quarters; they are in a building in steward's department. 

♦Information furnished by Steward's Department. 




SOUTH-WESTERN HOSPITAL DISTRICT, 

PENNSYLVANIA. 

STATE HOSPITAL AT DIXMONT, ALLEGHENY COUNTY. 

Population of District by Census of 1880, Number of square miles, 9,638. Acreage, 6,167,920. 



19 

20. Are there any anthracite or bituminous stoves or grates in posi- 
tions where the insane would have access to them? Only at the 
Farm Cottage and Stinson Cottage. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? With electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Yes. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes; they vary from one to 
three to a building; there are 19 in all; between 9.00 P. M. and 6.00 
A. M. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? Not un- 
less there are some for the steward's employes. 

27. *How "near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? About 
one mile; public; they are accessible. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes; call box and telephone. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. All patients ordered 
taken into fire-proof corridors. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 
their character? No. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission. No. 

MARY M. WOLFE, M. D., 
Resident Physician, Women's Department, Norristown State 
Hospital. 



STATE HOSPITAL FOR THE INSANE, DIXMONT, PA. 



1. What number of insane inmates are in your care? 750. 

2. Males? 414. 

3. Females? 336. 

"Information furnished by Steward's Department. 



20 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 4 — one main build- 
ing, capacity 400 patients; one annex building, capacity 125 patients; 
two frame cottages, capacity 30 patients each. 

5. Are there any violent cases which require separate confine- 
ment? Yes, such as insane criminals and epileptics; also consump- 
tives. 

6. Of what are your buildings constructed — frame, stone or brick? 
The main building and annex are brick; two cottages are frame (one- 
story) each. 

7. What is the width of the staircase connecting your different 
stories? Six feet. 

8. Are there front and back, or only single staircases? Front, 
back and side stairways. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) The sleeping rooms are on each floor 
averaging 15 rooms to each ward; the annex is a dormitory build- 
ing, also the two cottages. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? In fourth story one ward male and 
one ward female. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Yes; 
four large and complete fire escapes of iron construction; they ex- 
tend out to the hill side, easy access from each story. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Ordinary sized door, three and one- 
half feet say. 

13. How near do these fire escapes approach the ground? They 
reach the ground. 

14. Whence do you draw your w T ater supply? From the river for 
house use, or we have spring water in abundance for drinking and 
cooking purposes. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? All stories 
can be reached by our hose and stand pipes. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) Yes; Babcock 
extinguishers and 100 feet of hose in each ward. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 100 feet in each ward also stand 
pipes. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? By steam; boilers are located at 
the river; the patients have no access to them whatever. 



21 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? No; boilers are one-fourth mile 
away at river. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sition where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Lighted by gas (manufactured). 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Yes; by regularly appointed employes to light and 
turn out gas. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes; ten inside watchmen and 
one outside watchman. 

25. Do you allow smoking in the dormitories? No; no place in 
the building except in office a little in evenings.- 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Very 
handy and near. 

28. Have you telephone communication with any located fire ap- 
paratus? No. 

29. Have you any established rules in case of an alarm of fire-, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. Yes. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 
their character? No. 

II. A. HUTCHINSON, M. D. 

Superintendent. 
Dixmont, Pa., October 29, 1901. 



STATE ASYLUM FOR THE CHRONIC INSANE, SOUTH MOUN 
TAIN, WERNERSVILLE P. O., PA. 



South Mountain, Wernersville, P. O., 

October 30, 1901. 
A. K. Pedrick, Esq., Secretary Legislative Commission, 1510 Chest- 
nut Street, Philadelphia, Pa.: 
Dear Sir: Enclosed please find answers to questions of Legislative 



22 

Commission, to investigate the condition of Pennsylvania insane. 
Hoping the information may be satisfactory, 

I am yours truly, 

S. S. HILL, 
Superintendent. 



1. What number of inmates are in your care? 800. 

2. Males? 600. 

3. Females? 200. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 50 attendants; the 
actual capacity of the buildings is 800. 

5. Are there any violent cases which require separate confine- 
ment? An occasional case. 

6. Of what are your buildings constructed — frame, stone or 
brick? Brick and stone. 

7. What is the width of your staircases connecting your different 
stories? Three feet nine inches. 

8. Are there front and back, or only single staircases? Two 
front staircases. 

9. Upon what floors or story are there sleeping rooms? (State 
the number on each floor.) Buildings used for the patients are two 
stories in height. There are 8 sleeping rooms for attendants and 
two dormitories for patients on each floor. The 8 rooms for the at- 
tendants accommodate 8 people and the two dormitories together 
accommodate 100 patients. 

10. What is the elevation above the ground of your highest sleep- 
ing apartment used for the insane? 19 feet. 

11. Have you any outside fire escapes? If so, what stories do 
they reach, and how is access obtained to them from each floor? No 
outside fire escapes on buildings used for the insane. Our stair- 
ways are wide and constructed of slate and metal so that they may 
be used as fire escapes. 

12. What is the size of the doors or windows opening from the 
interior into the fire escapes? . 

13. How near do these fire escapes approach the ground? . 



14. Whence do you draw your water supply? From a stream flow- 
ing through the property of the Institution. 

15. What stories of your building are reached by water supply? 
What are the number and size of the vents upon each floor? Both 
stories of building are reached by water supply with natural pres- 
sure. The buildings are 125 feet lower than the point from which 
we take the water, and there is a pressure of about 60 pounds to the 
square inch. There are twenty-four three-eighth inch spigots and 



23 

four one-half inch spigots on each floor in addition to the supply to 
the water closets flush and bath tubs. 

16. Have you any hose attachments upon any floors? (If so, how 
many, and what is the size of the discharge pipe?) The hose attach- 
ments are outside of the buildings on a level with the first floor. 
They have a discharge pipe two and one-half inches in diameter. 

17. How many feet of hose have you ready for use upon each floor, 
and what is the size and length? A hose carriage with 250 feet of 
two and one-half inch hose is kept in each building occupied by the 
insane. In addition a hand fire extinguisher and twelve buckets of 
water are kept in buildings on each floor. 

18. How are your buildings heated. If heated by steam, are the 
boilers accessible to the insane? The buildings are heated by steam. 
The boilers are not accessible to the patients. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? The boilers are situated in a 
building built for the purpose apart from the other buildings. There 
is a generator for heating water for bathing purposes situated under 
each building, but these are not accessible to the patients. 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? One or two 
small anthracite stoves are used in out buildings 2,000 feet from the 
main buildings. 

21. Are your buildings lighted by electricity, illuminating gas or 
oil? Lighted by electricity. 

22. Is the lighting controlled by fixed rules or how is it governed 
and regulated? Controlled by fixed rules. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? The insane do not have access to the con- 
trol and supply of light. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many and between what hours? Three night watchmen and 
one woman are on duty on sleeping floors from 8.30 P. M. to 5 
A. M., one man is on duty outside of the building during the same 
hours. 

25. Do you allow smoking in the dormitories? Smoking is not al- 
lowed in the dormitories. 

26. Are there any dormitories directly over the kitchen? There 
are some sleeping rooms used by male employes which are situated 
directly over the kitchen. 

27. How near the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? The 
nearest fire engines are in Reading which is 10 miles distant. 



24 

28. Have you telephone communication with any located fire ap- 
paratus? We have telephone connections with Reading and all the 
fire companies. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods in case of alarm? If you 
have, please send copy of them. We have an organized fire brigade 
made up of attendants and employes. A copy of rules governing the 
same is appended. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? Some frame tenement buildings have been erect- 
ed on the land adjoining our ground at a distance of about 1,500 feet 
from our own buildings. 



INSTRUCTIONS FOR FIRE DEPARTMENT. 

Superintendent or Steward. 

Chief Marshal. — The marshal shall have control of, and direct, the 
company when in action either during a fire or when at practice. He 
shall see that all hose is thoroughly tested and all plugs in good 
working order. 

Chief Engineer. 

Asistant Marshal. — The assitant marshal shall have control of 
all pumps and machinery and shall give particular attention to the 
fire pump, hose and water valve. He shall see that all hose is in 
good working order and report any deficiency or breakage. 

Hosemen. — The hosemen shall see that all hose is properly laid and 
connected, and shall then take charge of the nozzles (two men to each 
nozzle), and remain at their post until relieved. 

Plugmen. — The chief plugsman and assistants shall take charge 
of the plugs assigned to them and shall see that the hose is properly 
attached. They shall remain at their post of duty until relieved. 

Pumpmen, — Day engineer in day time, night engineer at night. 
The pumpmen shall see that the pump is clean, well oiled, and in 
good working order at all times. They shall see that a sufficient 
pressure of water is. maintained and increased or decreased as di- 
rected. 

Firemen are the men regularly on duty in the boiler house. The 
firemen shall see that sufficient steam (90 pounds) is maintained 
at all times and shall not leave their post of duty for any reason. 

During Actual Service. 

The location of any man may be changed by direction of the mar- 
shal, if circumstances demand. 



25 

Patients. — The patients will be under the direction of the as- 
sistant physicians. The supervisor not assigned to duty, and the 
attendants in each dormitory not assigned to duty, shall remain on 
the ward and endeavor to quiet the excitable ones and prevent es- 
capes. No patients shall be removed from any ward not actually 
on fire, except by the direction of the physicians. 

Fire Alarm. 

Whistle, 1-4 1-4 1-4 



COUNTY INSTITUTIONS TO WHICH INSANE PATIENTS 
HAVE BEEN SENT FROM THE STATE INSTITUTIONS, 
VIZ: 

Adams County Almshouse for the Insane, Gettysburg. 

Allegheny City Home and Hospital for the Insane, Claremont. 

Allegheny County Home, Woodville. - 

Blair County Home for the Insane, Hollidaysburg. 

Cumberland County Hospital for the Insane, .... Carlisle. 

Chester County Hospital for the Insane, Embreeville. 

Elk County Hospital for the Insane, St. Mary's. 

Erie County Almshouse, Erie. 

Franklin County Almshouse, Chambersburg. 

Hillside Home Hospital for the Insane, Clarks Summit. 

Jefferson County Home, Brookville. 

Lancaster County Hospital for the Insane, Lancaster. 

Luzerne County (Central Poor District Hospital for 

the Insane), Retreat. 

Mercer County Hospital for the Insane, Mercer. 

Potter County Asylum, Coudersport. 

Philadelphia Hospital for the Insane, Philadelphia. 

Pittsburgh City Home for the Insane, Marshalsea. 

Somerset County Hospital for the Insane, Somerset. 

Washington County Home for the Insane, Arden. 



ADAMS COUNTY ALMSHOUSE— GETTYSBURG. 



1. What number of insane inmates are in your care? 38. 

2. Males? 20. 

3. Females? 18. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Two. Capacity, 45. 



26 

5. Are there any violent cases which require separate confine- 
ment ? No. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick, tin roof. 

7. What is the width of the staircases connecting your different 
stories? Three feet. 

8. Are there front and back, or only single staircases? Front 
and back. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor). First floor 22. Second 23. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 18 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Yes, one 
second story; by three foot doors from hallways. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Three feet. 

13. How near do these fire escapes approach the ground? Start 
from the ground. 

14. Whence do you draw your water supply? From tank on top 
second floor. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? Both are 
reached by water supply. Air vents 8 by 10. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe)? No hose. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? Two water plugs close to building, 
with 200 feet of 2-inch hose, with pressure to throw the water on any 
part of building. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? By hot air furnaces in the cellar. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them?' No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours - ? No. 



27 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Three- 
fourths of a mile. Public. Yes. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. Have none. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance and what is 
their character? None. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission? All kept 
in the same building. Two-story brick building with tin roof, 78 by 
33 feet, with annex 30 by 50 feet. 

CHAS. STRAUSBAUGH, 
Steward of Adams County Almshouse, Gettysburg, Pa. 



ALLEGHENY CITY HOME AND HOSPITAL FOR THE INSANE. 



Department of Charities, 
City of Allegheny, Pa., November 16, 1901. 

A. K. Pedrick, Esq., Secretary, 1510 Chestnut St., Philadelphia, Pa.: 

Dear Sir: Enclosed please find statement (as per request) of 
Allegheny City Home and Insane Asylum. 
Very respectfully, 

BARTON GRUBBS, 
Director Department of Charities. 



1. What number of inmates are in your care? November 1, 1901 
200 insane. 

2. Males? 108. 

3. Females? 92. 

4. How many attendants have you for the insane inmates, and 



28 

what is the actual capacity of your buildings? Six male and six fe- 
male attendants. Capacity 214. 

5. Are there any violent cases which require separate confine- 
ment? Only at times. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick. 

7. What is the width of the staircases connecting your different 
stories? 4 ft. 2 in. wide. 

8. Are there front and back, or only single staircases? Front 
and back. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor). 45 on first, 65 on second and 104 on third 
floors; 75 of this number to be removed to two-story building when 
completed. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 32 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Yes, 
reach all stories; access by doors. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Doors three feet wide. 

13. How near do these fire escapes approach the ground? Reach 
the ground. 

14. Whence do you draw your water supply? Allegheny City, 
60-inch water main, passing through the place, and connection with 
Allegheny County Workhouse water main. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? All stories. 
First floor 6-2-inch and 1-1-inch vent; second floor 5-2-inch and 1-1- 
inch vent; third floor 2-2-inch and 1-1-inch vent; attic 2-2-inch vent. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe)? Have stand pipe 
on all floors, 13-2-inch and 3-1-inch connections. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? Have 400 feet 2-inch and 50 feet 
1-inch on first floor; have 350 feet 2-inch on second floor; have 150 
feet 2-inch and 50 feet 1-inch on third floor; have 250 feet 2-inch in 
the attic. 

Also 10 Babcocks, 50 Killfyre, and water buckets filled with water 
distributed through the buildings. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Original buildings heated by 
steam, new buildings by hot air and modern ventilating system. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 



29 

buildings? If not, where are they? Boiler house is 100 feet in 
rear of main building. 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? None. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Gas. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Attended by officers of each department. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? None. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Have two attendants sleep 
in each ward; night nurses in hospital, and a night watchman. 

25. Do you allow smoking in the dormitories? Allowed to smoke 
in day rooms only. 

26. Are there any dormitories directly over the kitchen? None. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Can 
call on the Allegheny County Workhouse, which adjoins us. All 
local towns between here and Allegheny City, and City Fire Depart- 
ment. 

28. Have you telephone communication with any located fire ap- 
paratus? Can communicate with all by telephone. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy? Alarm by blowing steam 
whistle and ringing large bell, for the command of all fire apparatus 
around the building, by officers and assistants. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance and what is 
the character? None. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission? Have 
now seventy -two male patients in separate building which is two 
stories high, fire proof, costing over f 43,000, which was erected three 
years ago, and have now under progress of construction an addition, 
the two story male insane building, fireproof, and when completed 
will have a capacity for 140 male patients; also one separate female 
building two stories high, fireproof, with a capacity of eighty female 
patients, the whole costing over |110,000, and expect to be able to 
remove nearly all the insane patients from the main builddng. 

BARTON GRUBBS, 
Director Department of Public Charities. 



30 



ALLEGHENY COUNTY HOME. WOODVILLE, PA. 



1. What number of insane inmates are in your care? 335. 

2. Males? 192. 

3. Females? 143. 

4. How many attendants have yon for the insane inmates, and 
what is the actual capacity of your buildings? 14 males: 11 females. 
: ' -_ atients. 

5. Are there any violent cases whi:h require separate confine- 
ment? >':. except at intervals. 

6. Of what are yooi buildings ; instructed — frame, stone or brick? 
Stone, brick and iron. 

7. What is the width of the staircases connecting your different 
s t : :ies ? 10 feet. 8 ire: and 1 feet. 

S. Are there front and back, or only sing] -ases? Front 

and back. 

9. Upon what rb: :r or story are there sleeping rooms? State the 
number on each floor). First and second. 7 on first. 56 patients, 
7 on second. 2SS patients. 

10. What is the elevation above the ground of tout highest sleep- 
ing apartments used for insane? 20 feet. 

11. Have you any mtside i:r escapes 1 I: so, what storief 
they reach, and how is access obtaine 1 : : them from each floor? No 
outside escape. 

12. What is the size of the doors and windows opening item the 
:::rii:r into the fire escapes? 

13. How near ik these ±:r escapes approach the ground? 

14. Whence do you draw your water supply? Wells, city and 
Chartiers aeek. Pings in each mrt, about 90 ms. pressure. 

15. What s::ries of your building are reached I y water sup] 
What are the number and size of vents upon each floor? All floors. 

16. Have you any hose attachments upon any floor? I: so, how 
many, and what is the size of the lis charge pipe)? None. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 

IS. How are your buildings heated? If heated by steam, are the 
t nlers accessible to the insane? Steam. B:iirrs in s^t : i "ate build- 
ing, about 200 feet from main building. 

19. If heated by steam, err the ": filers wi-Lin the main buildings? 
Are there any 1 lifers for beating or manufacturing within the- main 

lings? If not. where are they? None. 

20. Are there any anthracite or bituminous stoves w grates in 
positions where the insane would have access to them? Xo. 



31 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? By attendants or officers with private key. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes, 6 all night. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Two 
miles. ; 

28. Have you telephone communication with any located fire ap- 
paratus? No. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them? No. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance and what is 
their character? No. 

31. Are the insane patients for which yon receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission? No. Our 
building is as near fireproof as modern architecture can make it; 
floors concrete, stairs iron, and nothing of an inflammable character 
in the building. 

S. W. LEA, 
Superintendent Allegheny County Hospital for Insane. 



BLAIR COUNTY HOME FOR THE INSANE, HOLLIDAYSBURG. 



Hollidaysburg, Pa., November 14, 1901. 

Sub-Committee of the Legislative Commission of Pennsylvania In- 
sane: 
Gentlemen: I enclose herewith answers to interrogatories re- 
quested in a letter from your Secretary, Mr. A. K. Pedrick, dated No- 
vember 11. I will send you photographs in a few weeks. Have ar- 
ranged to have some taken so that we can show you the plan of our 
buildings. 



32 

Any information that I can furnish you at any time will be given 
cheerfully. We would be glad to haTe the Commission visit our 
Hospital and learn of the work done here since March, 1S98. If this 
is impossible I will go before your Commission at any time and 
answer any interrogatories in reference to County Care of Indigent 
Insane. 

Very respectfully yours, 

P. H. BRIDEXBAUGH. 



1. What number of insane inmates are in your care? 97. 

2. Males? 47. 

3. Females? 50. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Three female and 
two male attendants; capacity, 120 insane. 

5. Are there any violent cases which require separate confine- 
ment? Sometimes we have from four to five violent; but at the pres- 
ent time we have no violent cases. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick. 

7. What is the width of the staircases connecting your different 
stories? Iron stairs four feet wide; these are good solid iron stairs — 
no wood whatever about them. 

8. Are there front and back, or only -single staircases? Center, 
rear and outside. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor.) Sleeping rooms on both floors; but second 
floor used exclusively for the insane; our sleeping rooms are large 
dormitories. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 11 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Yes; 
they reach second floor. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Doors opening on to fire escapes, 
three and one-half feet wide. 

13. How near do these fire escapes approach the ground? They 
reach to the ground. 

14. Whence do you draw your water supply? From mountain 
stream; conies to us three and one-half miles by gravity. 

15. What stories of your building are reached by water supply? 



33 

What are the number and size of vents upon each floor? All the 
stories have water on them, but our hose attachments are on the 
outside. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) None. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? Have 300 feet of hose for all fire 
purposes. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? With steam ; boilers not accessible 
to the insane. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
building? If not, where are they? Large heating boiler is under 
male ward. Boiler for laundry work and other purposes is in a 
separate building near the barn. 

20. Are there any anthracite or bituminous stoves or grates in po 
sitions where the i, sane would have access to' them? There are 
not. W T e have no stoves in the building except in kitchens. 

21. Are your buildings lighted with electricity, illuminating ga* 
or oil? Electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Light is obtained from plant at Hollidaysburg, on^ 
and one-half miles from building. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? Insane have no access to the control or sup 
ply of light. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Have attendants on sleeping 
floors with the insane. 

25. Do you allow smoking in the dormitories? We do not. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? One and 
one-fourth mile and accessible in an emergency. 

28. Have you telephone communication with any located fire ap 
paratus? We have. 

29. Have you established rules in case of an alarm of fire, or have 
you any organized or printed methods to pursue in case of alarm? 
If you have, please send copy of them. Do not have printed rules, 
but have the employes trained to handle hose, etc. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at wiwt distance, ana vW 
is their character? There are none : 



34 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic view 
of the same for use in the report of the Commission. Our insane are 
kept in separate wards from other inmates; have separate dining 
rooms. Will have photographic view of front and rear of buildings 
taken and will send them to you. 

P. H. BRIDENBAUGH, 

Superintendent. 



CUMBERLAND COUNTY HOSPITAL FOR THE INSANE, CAR- 
LISLE, PA. 



1. What number of insane inmates are in your care? 74. 

2. Males? 33. 

3. Females? 41. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Eight attendants. 
Capacity, 85. 

5. Are there any violent cases which require separate confine- 
ment? No. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick. 

7. What is the width of the staircases connecting your different 
stories? Three feet nine inches. 

8. Are there front and back, or only single staircases? Front 
and back staircases. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) On the four stories: First floor, four; 
second floor, six; third, thirteen; fourth, eleven. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 32 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Two out- 
side fire escapes reach from upper floor to near ground, access ob- 
tained through window three feet wide and five feet eight inches high 
to enter either escape. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Three feet by five feet eight inches. 

13. How near do these fire escapes approach the ground? Eight 
feet. Iron ladder from these to ground. 



35 

14. Whence do you draw your water supply? From nearby spring 
into 50,000 gallon tank. Elevated 52 feet. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? Water sup- 
ply reaches all stories. One vent one and one-fourth inch on each 
floor. 

16. Have you any hose attachment upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) One on each floor 
one inch each. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? Eighty feet on each floor; one and 
one-half inch hose. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Steam. No. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? Yes; boiler for heating water 
and cooking in same building. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sitions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas or 
oil? Electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Fixed rules. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes; two, all night. 

25. Do you allow smoking in the dormitories? Yes. 

26. Are there any dormitories directly over the kitchen? Yes. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? One 
mile; yes. 

28. Have you telephone communication with any located fire ap- 
paratus? No; but have a telephone and can reach Carlisle, which 
is one mile away. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. No. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 
their character? None near. 

31. Are the insane patients for which you receive State aid, kept in 
a separate building from the other patients? Describe the building 



36 

in which they are kept, and if possible, supply a photographic view 
of the same for use in the report of the Commission. All in same 
building. 

The "State aid" patients and "private paid" patients are all kept 
in the same building, which is a three-story and basement substan- 
tial brick building, modern, with iron stairs and practically fire-proof. 
We have no photograph — if you must have one please advise and we 
will have one taken. 

FRANCIS MENTZER, 
Steward, Cumberland County, Pa. 



CHESTER COUNTY HOSPITAL FOR THE INSANE, EMBREE- 

VILLE, PA. 



Embreeville, Pa., November 18, 1901. 

Alexander K. Pedrick, Secretary, 1510 Chestnut Street, Philadelphia, 

Penna. : 

Dear Sir: Enclosed please find blanks filled as requested in your 
communication of the 11th. Views of the hospital have been taken, 
but for some unknown reason the photographer has not sent them, 
which will explain to you the late arrival of the enclosed blanks. 
Will forward views when received. 

Very truly, 

JANE R. BAKER, 
Superintendent. 



1. What number of insane inmates are in your care? 170. 

2. Males? 96. 

3. Females? 74. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Two nurses, and 
fourteen attendants. One hundred and ninety. 

5. Are there any violent cases which require separate confine- 
ment? One case; woman. 

6. Of what are your buildings constructed— frame, stone or brick? 
Stone foundation and brick. 



37 

7. What is the width of the staircases connecting your different 
stories? Five feet ten and one-half inches wide in center building; 
four feet six inches front stairway in ward; four feet back stairway in 
ward. Iron and slate used in construction. 

8. Are there front and back, or only single staircases? Front 
and back staircases. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) First floor two dormitories, twelve 
rooms; second floor, two dormitories thirteen rooms. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? Eighteen feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Two are 
on men's ward, one on women's; open into corridor from each floor 
by an outside door. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? One door two feet nine inches wide 
and seven feet long on each floor. 

13. How near do these fire escapes approach the ground? Last 
step six inches from the ground. 

14. Whence do you draw your water supply? Gravity supply from 
hills above hospital building, with a reservoir with a containing ca- 
pacity of gallons. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? 'Second — 
hose attachment two inch nine faucets, one-half inch nine faucets on 
lower ward on each wing one-half inch fire in center; two in base- 
ments one-half inch. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) Second floor of 
each wing one two inch and one in the center building in second 
floor two inch pipe and two on first floor. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? None — matter before the board of 
directors; bids have been received. 

18. How are your buildings heated ? If heated by steam, are the 
boilers accessible to the insane? Steam power house sixty yards 
from building, and insane not employed in power house. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? Only boiler in building hot 
water boiler, which is in a part of basement, to which patients do 
not have access. 

20. Are there any anthracite or bituminous stoves or grates in 



38 

positions where the insane would have access to them? Laundry, 
two stoves ; kitchen range, with two tires, cared for by employes. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Electric light from 5 A. M. until light. In P. M. 
from dark to 9 P. M. Night nurses use lanterns. Directors antici- 
pate the use of storage battery for night use. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have yon watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Night nurse or nurse wards 
from six to six. On women's wards from six to six. (These alone 
from 9 P. M. to 5.30 A. M). 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Seven 
miles. Yes. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes, with two, each seven miles distant. 

29. Have you any established rules in case of alarm of fire, or have 
you any organized or printed methods to pursue in case of alarm? 
If you have, please send copy of them? Patients are taken over the 
fire escapes every day, when taken to walk in A. M. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 
their character? No building within 60 yards. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission. Insane 
in hospital 100 yards from almshouse. Hospital consists of centre, 
two day rooms and wings. A modified Kirkbride architectural plan 
and is of fireproof construction. Congregate dining room. Indirect 
radiation in part of building occupied by patients and all exposed 
piping covered with asbestos. Chapel with seating capacity for 180. 

JANE R. BAKER, 
Superintendent. 



ELK COUNTY HOSPITAL FOE THE INSANE, ST. MARY'S, PA. 



1. What number of insane inmates are in your care? 23. 

2. Males? 13. 



39 

3. Females? 10. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Two and 50. 

5. Are there any violent cases which require separate confine- 
ment? 1. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick. ; 

7. What is the width of the staircases connecting your different 
stories? 3 ft. 8 in. 

8. Are there front and back, or only single staircases? Single. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor). All on first floor. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? Four feet. 

11. Have you any outside fire escapes? If so, what stories do 
they reach, and how is access obtained to them from each floor? 
None. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? None. 

13. How near do these fire escapes approach the ground? . 

14. Whence do you draw your water supply? From a reservoir 
constructed by county for our institution only. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? Can reach 
any part of building. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe)? A fire hose and 
complete fire apparatus through entire building, lj-inch discharge 
line and 40 pounds pressure. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? Six hose reels, 50 feet each reel. 
Jacket hose, 2J-inch inside. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? By steam, boilers are isolated. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? Boilers are in a separate build- 
ing underneath laundry. 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? None. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Gas. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? By fixed rules, inmates are not allowed to trifle 
with gas. 



40 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Man in charge at all times. 

25. Do you allow smoking in the dormitories? No, sir. 

26. Are there any dormitories directly over the kitchen? No, sir. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible iu an emergency? Two 
miles, public service. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes. 

29. Have you any established rules in case of alarm of fire, or have 
you any organized or printed methods to pursue in case of alarm? 
If you have, please send copy of them. No printed rules. 

30. Are there any buildings of an inflammable character located 
uear or adjoining your own? If near, at what distance, and what is 
their character? None whatever. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission? All our 
insane are kept in an annex constructed especially for that purpose; 
they are connected by long halls or corridors. The entrance to 
annex is fifty feet from main or pauper building. 

J. W. DE HAAS, 
Elk County Home. 



EKIE COUNTY ALMSHOUSE, ERIE, PA. 



Average number inmates sane and insane, 200. 

1. What number of insane are in your care? 58. 

2. Males? 24. 

3. Females? 34. 

4. How many attendants have you for the insane inmates: one 
male, one female; and what is the actual capacity of your buildings? 
Male, 14; female, 24. 

5. Are there any violent cases which require separate confine- 
ment? No. 

6. Of what are your buildings constructed — frame, stone or brick? 
Male, frame; female, brick. 



41 

7. What is the width of the staircases connecting your different 
stories? Female, front double three feet each; back single three feet 
each. Male on ground floor. 

8. Are there front and back, or only single staircases? Female, 
double front, single back. Male ground floor. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) Female second story. Male ground floor. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? Second story, eighteen feet. 

11. Have you any outside fire escapes? Yes. If so, what stories 
do they reach, all; and how is access obtained to them from each 
floor? By windows. 

12. What is the size of the doors and windows opening from the in- 
terior into the fire escapes? Two and one-half and three feet. 

13. How near do these fire escapes approach the ground? All 
reach the ground. 

14. Whence do you draw your water supply? Natural springs. 
Water forced to tanks in upper stories; 500 barrels held in tanks. 

15. W T hat stories of your building are reached by water supply? 
All. What are the number and size of the vents upon each floor? 
Two and one-half inch. 

16. Have you any hose attachments upon any floor? On all. (If 
so, how many, and what is the size of the discharge pipe?) Two and 
one-half inches. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size? 50 feet, and 2J inches in diameter. 

18. How are your buildings heated? By steam and natural gas. 
If heated by steam, are the boilers accessible to the insane? No. 

19. If heated by steam, are the boilers within the main buildings? 
Yes; in basement. Are there any boilers for manufacturing within 
the main building? No. If not, where are they? . 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? None. 

21. Are your buildings lighted with electricity, illuminating gas, 
or oil? Natural gas. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Yes; some lights fixed hours, others all night. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? Yes. 
If so, how many and between what hours? 8 P. M. until daylight. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? None 
for insane. 



42 

27. How near to the buildings are the nearest fire engines? Erie 
City, four miles. Whether public or private, and are they accessible 
in an emergency? Possibly. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes, with city. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. No printed rules. 
All employes orally instructed. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 
their character? Small out buildings, such as ice house, hen house, 
etc., within 100 feet. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic view 
of the same for use in the report of the Commission. Males for 
whom we receive no aid, in separate frame; females in ward, on 
second story of main building. 

0. W. ZUCK, 

Steward, 
per C. B. GRANT, 

Clerk. 
November 15, 1901. 



FRANKLIN COUNTY ALMSHOUSE, CHAMBERSBURG, PA. 



1. What number of insane inmates are in your care? Thirty- 
three (33). 

2. Males? Nineteen (19). 

3. Females? Fourteen (14). 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Two, one for the 
males and one for the females. Buildings will accommodate 
forty (40). 

5. Are there any violent cases which require separate confine- 
ment? Two. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick. 

7. What is the width of the staircases connecting your different 
stories? One three and one-half feet and one four feet. 

8. Are there front and back, or only single staircases? Front 
and back. 



43 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor). On both floors. — 14 rooms on lower and 
19 on upper floor. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? Fourteen feet. 

11. Have you any outside fire escapes? If so, what stories do 
they reach, and how is access obtained to them from each floor? 
Two outside fire escapes for the second floor. Both accessible 
through windows. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? One four feet and the other two feet. 

13. How near do these fire escapes approach the ground? Within 
a foot. 

14. Whence do you draw your water supply? There is a large 
tank on the top of the building. This is supplied by a pump at the 
spring. A constant flow. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? Both floors 
are supplied with water. There are four vents on each floor. 

16. Have you any hose attachments upon any floor? '(If so, how 
many, and what is the size of the discharge pipe?) We have no hose, 
but each floor is supplied with fire extinguishers. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? . 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? By steam. The boilers are not ac- 
cessible to the insane, but are in a separate building about 80 feet 
from the insane department. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? No. The boilers are in a sepa- 
rate building. There are no boilers for heating or manufacturing in 
the insane buildings. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sitions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Lighted with electricity. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Controlled by fixed rules. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? One watchman on duty from 
6 P. M. to 6 A. M. 

25. Do you allow smoking in the dormitories? No. 



44 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? One 
and one-half miles — are accessible in an emergency. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes. 

29. HaYe you any established rules in case of alarm of fire, or have 
you any organized or printed methods to pursue in case of alarm? 
If you have, please send copy of them. No. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? No. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission. They are 
kept in a separate building. The building is a two-story brick build- 
ing. The height of the stories is eleven feet. The building is 110 
feet long and 42 feet wide. 

JACOB POTTER, 
Steward, Franklin County Almshouse. 
P. O. Chambersburg, Franklin County, Pa. 



HILLSIDE HOME HOSPITAL FOE THE INSANE, SCRANTON, 

PENNA. 



Clarks Summit, Pa., November 16, 1901. 

A. K. Pedrick, Secretary, 1510 Chestnut Street, Philadelphia: 

Dear Sir: Enclosed please find report of questions answered ac- 
cording to your request. We also mail under separate cover, a few 
photographs. Please acknowledge receipt thereof. 

We have had exterior views of the buildings taken, and as soon as 
finished will mail you a few. 

Yours truly, 

GEO. W. BEEMER, 

Superintendent. 



1. What number of insane inmates are in your care? 262. 

2. Males? 126. 

3. Females? 136. 



45 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 18, including night 
attendants, actual capacity 275. 

5. Are there any violent cases which require separate confine- 
ment? Yes, temporarily. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick. 

7. What is the width of the staircases connecting your different 
stories? Three and one-half feet. 

8. Are there front and back, or only single staircases? Center 
and rear staircases. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) First floor, IS; second floor, 20; third 
floor, 20. No. 7 or epileptic ward, 6. 

io. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 25 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Yes; 
reach all stories, access by door and are used daily. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Two feet ten inches. 

13. How near do these fire escapes approach the ground? Con- 
nected from each story to the ground. 

14. Whence do you draw your water supply? Deep drilled- well. 
Water is discharged from well to reservoir by means of compressed 
air. 

15. W^hat stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? All stories. 
Each room is ventilated by an eight by ten inch vent. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) One for each 
floor, pipe two and one-half inch. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 100 feet on each floor; two and one- 
half inch. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? By steam. Boilers are not acces- 
sible to patients. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? No. 500 feet away. 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electricity. 



46 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Fixed rules and controlled from steam plant or 
power house. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Five night nurses all night. 

25. Do you allow smoking in the dormitories? Patients are al- 
lowed a smoke after each meal. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private and are they accessible in an emergency? Fire 
engine is located in power house, and is automatic, with a separate 
water line for that purpose. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. We have a separate 
hose carriage for outside protection, with a recognized fire alarm, 
and daily use of fire escapes. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? No. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission. Yes. The 
administration building and dining hall for patients are located in 
the center, the wards for insane being on the north and south. 
Under separate cover we mail you photographs of one male ward 
and one female ward as taken from the main building, also one of the 
main office and of the dispensary. 

GEORGE W. BEEMER, 

Superintendent. 



JEFFERSON COUNTY HOME. 



1. What number of insane inmates are in your care? 9. 

2. Males, 3. 

3. Females? 6. 

4. How many attendants have you for the insane inmates, an4 
what is the actual capacity of your buildings? %, 



47 

5. Are there any violent cases which require separate confine- 
ment? No. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick. 

7. What is the width of the 'Staircases connecting your different 
stories? 5 feet. 

8. Are there front and back, or only single staircases? 4 stairs 
leading to second story. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) Insane sleeping rooms are all on first 
floor. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? . 

11. Have you any outside fire escapes? If so, what stories do 
they reach, and how is access obtained to them from each floor? No. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes ? . 

13. How near do these fire escapes approach the ground? . 

14. Whence do you draw your water supply? From reservoir on 
hill. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? Second 
story. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) Yes. Size of 
discharge pipe one and one-fourth inches. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 200 feet on each floor; one andi one- 
fourth inches. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Heated by steam. Boilers not ac- 
cessible to insane. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? Boilers are in separate build- 
ing 20 feet from main building. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sitions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Gas. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Yes. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 



48 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? No. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? There 
are no fire engines nearer than DuBois, 24 miles. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. No. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 
their character? No. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission. The in- 
sane are kept' in insane wards attached to main building one-story 
high. Males in one ward and females in another one. 

County Commissioners of Jefferson County. 
Brookville, December, 1901. 



CENTRAL POOR DISTRICT OF LUZERNE COUNTY, HOSPITAL 
FOR THE INSANE, RETREAT, PA. 



Retreat, Pa., December 1, 1901. 
Alex. K. Pedrick: 

Dear Sir: Enclosed you will find answers to questions intended 
for this hospital. The form did not reach us until a few days ago, 
and hence the delay in returning it to you. Our report for 1900, 
mailed you to-day, will give information which cannot be included 
in the answers. 

Very truly yours, 

CHAS. B. MAYBERRY. 



1. What number of insane inmates are in your care? 366. 

2. Males? 206. 

3. Females? 160 f 



49 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 34 attendants. Ca- 
pacity of hospital for insane is 450. 

5. Are there any violent cases which require separate confine- 
ment? Two female patients are at present secluded for violence. 

6. Of what are your buildings constructed — frame, stone or brick? 
Stone and brick. 

7. What is the width of the staircases connecting your different 
stories? Five feet; fire proof. 

8. Are there front and back, or only single staircases? Six stair- 
cases run from the floors occupied by patients to the ground. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor.) Capacity for each wing is: First floor, 75; 
second floor, 100; third floor, 50; total, 225. Of two wings 450. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? Highest sleeping apartments are 
on the third floor which is 30 feet and 6 inches from the ground. 

11. Have you any outside fire escapes? If so, what stories do 
they reach, and how is access obtained to them from each floor? 
There are two outside fire escapes for each wing — four in all. They 
reach all stories. Access is obtained by windows which are pro- 
tected by locked screen doors. 

12. What is the size of the doors and windows opening from the in- 
terior into the fire escapes? Width of windows at fire escapes, three 
feet and seven inches. 

13. How near do these fire escapes approach the ground? Six and 
one-half feet. 

14. Whence do you draw your water supply? Spring water 
pumped into a tank sufficiently high to give a pressure of 80 pounds. 
Supply is almost unlimited. Capacity of tank 100,000 gallons. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? All stories 
in the ward wings. Two stand-pipes for each wing and one for the 
centre. Size two and one-half inches for fire hose. Hot and cold 
water pipes in every part of the building. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) Fire hose at- 
tachment on each floor and five in the basement. Size of discharge 
pipe, two and one-half inches. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 250 feet on each floor, two and one- 
half inches. 600 feet of three inch hose for outside hydrants and a 
hose cart. 

18. How are your buildings heated? If heated by steam, are the 



50 

boilers accessible to the insane? Heated by steam. Administra- 
tion building by direct radiation. Ward wings by indirect radia- 
tion — the blast system. The boilers are not accessible to patients. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? Boilers are in the boiler house 
1,000 feet away from the hospital. None in the main building. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sitions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electricity. Direct 110 volt current. 

22. -Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Dynamo started in the engine house. Light turned 
on in the wards by keys. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? . 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Two males and two female 
night nurses — four for the two wings. Night service is continuous 
with day service. Change is at 9.30 P. M. continues to 5.30 A. M. 
One of the male nurses also acts as watchman for the administration 
building. 

25. Do you allow smoking in the dormitories? No smoking is per- 
mitted in the wards. 

26. Are there any dormitories directly over the kitchen? No. 
The kitchen is a different building connected with the main building 
by the covered passage which is fire proof. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? No fire 
engines are considered necessary as the water pressure is 80 pounds, 
which is sufficient to throw water over the highest part of the build- 
ing. Hydrants are placed at frequent intervals about the building. 

28. Have you telephone communication with any located fire ap- 
paratus? Long distance telephone connects us with Wilkes-Barre 
and Nanticoke. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. Verbal instructions. 
Frequent drills in the use of outside hose. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? All buildings are fire proof. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic view 



51 

of the same for use in the report of the Commission. This institu- 
tion is a hospital for the insane and has no connection with the 
Central Poor District Almshouse. It is built and organized on the 
most advanced plans for the treatment of the insane. Under an- 
other cover the last report of the hospital for the insane is sent to 
your committee. This will give you more information than any 
short description can. 

CHAS. B. MAYBERRY, 
Superintendent and Chief Physician. 



LANCASTER COUNTY HOSPITAL FOR THE INSANE, LAN- 
CASTER, PA. 



1. What number of insane inmates are in your care? 167. 

2. Males? 94. 

3. Females? 73. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Six males, five fe- 
males; capacity, 250. 

5. Are there any violent cases which require separate confine- 
ment? No. 

6. Of what are your buildings constructed — frame, stone or brick? 
Iron, brick and stone. 

7. What is the width of your staircases connecting the different 
stories? Seven feet. 

8. Are there front and back, or only single staircases? Front 
and back. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) . 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 25 feet. 

11. Have you any outside fire escapes ? If so, what stories do they 
reach, and how is access obtained to them from each floor? Yes. 
All stories by windows and doors. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Three and one-half feet. 

13. How near do these fire escapes approach the ground? To 
ground. 

14. Whence do you draw your water supply? City. 



52 

15. What stories of your building are reached by water supply? 
What are the number and size of vents- upon each floor? All. 
Twelve, one-half and three-fourths. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) Yes. Two on 
each, two inch. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 200 feet; one and one-half inches; 
100 feet each. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? No. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
buildings? If not, where are they? No; in almshouse. 

20. Are there any anthracite or bituminous stoves or grates in posi- 
tions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electricity and gas. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Fixed rules; by attendants. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes; one every hour. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Public; 
six blocks, accessible, two minutes. 

28. Have you telephone communication with any located fire ap- 
paratus? Yes. 

29. Have you any established rules in case of an alarm of fire, 
or have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. Sound the alarm. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 
their character? No. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission. Have 
forwarded you photograph of insane. 

WILLIAM GOOD, 
Lancaster County Almshouse Hospital. 



53 
MEECER COUNTY HOSPITAL FOR THE INSANE, MERCER, PA. 



1. What number of insane inmates are in your care? 59. 

2. Males? 43. 

3. Females? 16. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Four day attendants 
and two night watchers. About 65. 

5. Are there any violent cases which require separate confine- 
ment? No. 

6. Of what are your buildings constructed — frame, stone or brick? 
Stone and brick. 

7. What is the width of the staircases connecting with your 
different stories? At the ends 3J feet; center 4 feet 8 inches. 

8. Are there front and back, or only single staircases? There 
are stairways at each end of the building and a double stairway 
in the center. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor.) . 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 18J feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? No. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? . 

13. How near do these fire escapes approach the ground? . 

14. Whence do you draw your water supply? Supplied from a 
spring; then we have a tank holding 235 barrels on the fourth floor. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? All 1J inch; 
there are two on each floor. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe)? Two; 1J inch. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? We have none at present; our 
hose are practically worn out or rather rotted out. 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Heated by steam; boilers not 
accessible to the insane. 

19. If heated by steam, are the boilers within the main buildings? 
No. Are there any boilers for heating or manufacturing within the 
main buildings? No. If not, where are they? They are in a sepa- 
rate building. 



54 

20. Are there any anthracite or bituminous stoves or grates in 
positions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil ? Gas. 

22. Is the lighting controlled by fixed rules? Yes. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil ? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Two. They go to work at 8 
P. M. and quit at 7 A. M. 

25. Do you allow smoking in the dormitories? Yes. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? None. 

28. Have you telephone communication with any located fire ap- 
paratus? No. 

29. Have yon any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of an 
alarm? If you have, please send copy of them. No. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? The nearest is a frame dwelling house used 
now as a place to lodge tramps ; distance from nearest point of main 
building, 120 feet. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible, supply a photographic 
view of the same for use in the report of the Commission. No; they 
are kept in wards on the second floor of the main building. 

. J. S. WALLACE, 
Treasurer. 



POTTER COUNTY ASYLUM, COUDERSPORT, PA. 



Coudersport, November 10, 1901. 
A. K. Pedrick, Secretary: 

Dear Sir: We have at present no asylum in Potter county, but are 
building one, and expect it to be completed in May, 1902. 

JOHN B. COULSON, 
Clerk to County Commissioners. 



55 



BUREAU OF CHARITIES, PHILADELPHIA, BLOCKLEY POOR- 
HOUSE, PHILADELPHIA, PA. 



Philadelphia, November 2, 1901. 

Alexander K, Pedrick, Secretary, 1510 Chestnut Street, Philadel- 
phia, Pa.: 

Dear Sir: Answering your letter of October 26th, enclosed you 
will please find the questions answered. Having been in authority 
in this institution but a short time more than a year we do not wish 
at this time to express any special recommendations in connection 
with these matters. 

Yours very truly, 

W. M. GEARY, 
Supt. Bureau of Charities. 



1. What number of insane inmates are in your care? 1,472. 

2. Males? 700. 

3. Females? 772. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? 130 insane attend- 
ants. Actual capacity about 1,000. 

5. Are there any violent cases which require separate confine- 
ment? 12 in rooms; doors open; no restraint. 

G. Of what are your buildings constructed — frame, stone or brick? 
Stone and brick. 

7. What is the width of the staircases connecting with your 
different stories ? Five feet. 

8. Are there front and back, or only single staircases? Yes. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor). Three buildings, male, are three-story and 
one building two-story; three buildings, female, are three-story and 
one building two-story. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 31 feet from ground. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Fire 
escapes to all buildings. Direct access from each floor. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? 4 ft. x 7 ft. 

13. How near do these fire escapes approach the ground? Land 
on ground. 



56 

14. Whence do you draw your water supply? City water mains. 

15. What >::::- :>i your building bed by water supply? 
What are the number and size j£ rents upon taeh floor? All floors 
haYe ample water supply, each ward two one-naif inch Yenrs and 
a- 2-inch Yent. 

16. HaYe you any hose attachments upon any door? If so. hew 
many, and what is car size :: the iischargc Yes. One ar- 
tachment for each ward. 2-inch pipe. 

17. Hew many ee ;: hose have yon ready for use upon each door, 
and what is its sier and Length? Ea:h ward has 10( Zrr. 2^-incb 
linen hose. 

IS. How are your buildings heated? If heated by steam, are the 
boilers accessible to ear insane? By seeam. Boilers not accessible 
to the insane. 

19. It heated by steam, are the boilers within the main buildings? 
Are chrir any I tilers for he ating or manufacturing wiehin the main 
buildings? Ii no: where are they"; Xo. In a central plant about 
250 irr: from centre of block of building-. 

20. Air there any anthracite or bituminous stoves :r grates in 
position where the insane wonld have access tc cLria? No* 

21. Air yom buildings lighted with electricity, illuminating gas 
:r Ml? Elr::ri:i:y and iUiuninating gas. No oil. saYe in night 
men*s lanterns. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Fixed roles. 

23. Do the inss bss tc the control md supply of light] 
whether by gas or oil? No. 

24. HaYe yen watchmen at nighi upon the sleei ing floors? I: so, 
how many, and " n what boors? Every ward has :ne ar two 
and a general pati :": visiting wards hourly. Hours on duty B P. M. 
to 7 A. M. 

25. Do yen allow smoking in thr dormitories? No. 

26. Are there any dormitories directly >ver ehr kitchen? No. 

27. How near to the buildings are ~he neai sst fire engines, wae:her 
public :: private, end are they : essible in an emergency? One 
chemical enginr and one steam fire engine :n grounds ready, and 
public fire station within four minutrs. 

28. Have you telephone communication with any located fire ap- 
paratus? YeSj rect fire alarm. 

29. Have you any established rules in !ase :_ an alarm of fire, r 
haYe you any organized :: printed methods fee pursue in case of an 
alarm? If you ] ad jpy of them. No. Bureau of 
Fire, city of Philadelphia, has e ranpany of four men stationed in 
the grounds. 




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57 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what 
is their character? Building of the Commercial Museum, built of 
wood and iron, 250 feet south. 

Respectfully submitted. 

W. M. GEARY, 
Supt. Bureau of Charities, Philadelphia, Pa. 
November 2, 1901. 



PITTSBURGH CITY HOME FOR THE INSANE, MARSHALSEA. 



Pittsburgh City Farm, 

Marshal sea, Pa. 

A. K. Pedrick, Secretary, 1510 Chestnut Street, Philadelphia, Pa. : 

Dear Sir: Complying with your request of the 11th inst., I here- 
with submit answers to the questions submitted by you. I have 
answered them as fully as I have understood them and if further 
information is desired I will be glad to furnish it at any time. 

Very respectfully, 

GEO. LINDERMAN, 

Superintendent. 
Boyce P. O., Pa., November 14, 1901. 



1. What number of insane inmates are in your care? 469. 

2. Males? 246. 

3. Females? 223. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Males 20, females 
16, or one attendant to every thirteen and one-fourth patients. 

5. Are there any violent cases which require separate confine- 
ment? Yes. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick, slow combustion. 

7. What is the width of the staircases connecting your different 
stories? Fireproof stairway five feet wide, going from first to third 
floor. Small stairway in rear, going to second floor, 2 feet 6 inches. 

8. Are there front and back, or only single staircases? Stair- 
cases in front and fire escapes in rear. 



58 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor). Sleeping rooms on each floor. In male 
asylum, first floor, there are 10 rooms of various sizes. On the 
second floor there are 26 rooms of various sizes, including a large 
dormitory, with at present 38 beds. On the third floor there are 
44 sleeping rooms of various sizes. In the female asylum there are 
on the first floor 10 sleeping rooms. On the second floor there are 
26 sleeping rooms and on the third floor there are 26 sleeping rooms. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for the insane? 25 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Yes. 
There are two separate fire escapes on the male building and one 
on the female building. The escapes are reached by a doorway 
3 ft. 2 in. by 8 ft. leading from main corridor of each floor. These 
escapes reach down to the exercise yard and on all suitable days the 
patients are marched down the escapes to the yard and in this way 
they have become thoroughly familiar with the use of the escapes. 

12. What is the size of doors and windows opening from the 
interior into the fire escapes? The door above described is the only 
opening. 

13. How near do these fire escapes approach the ground? They 
go entirely to the ground. 

14. Whence do you draw your water supply? We have our own 
water works, drawing our supply from the Chartiers creek flowing 
through the farm. This water is used for flushing, cleaning, laundry 
and boiler purposes, while the water for drinking and culinary pur- 
poses is obtained from seven artesian wells drilled on different parts 
of the farm. We have two single action and one double action 
Wilson and Snyder pumps with a capacity of 40,000 gallons per 
hour. We have three reservoirs with a capacity of 750,000 gallons. 
Our consumption is 300,000 (gallons) every 24 hours. 

15. What stories of your building are reached by water supply? 
W T hat are the number and size of vents upon each floor? Water 
reaches all parts of all buildings. Vents are three feet, two in male 
and one in female building. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) Hose attach- 
ments on every floor. There are two stand pipes on each floor, 100 
feet of hose extending full extent of ward. The pressure is 50 
pounds to square inch, also Babcock fire extinguishers on each ward. 
Hose is two inch. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and strength? 100 feet of two inch hose. 



59 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? By hot air. 

19. If heated by steam, are the boilers within the main building? 
Are there .any boilers for heating or manufacturing within the main 
buildings? If not where are they? The boilers are in the power 
house, a separate building 175 feet from asylum buildings. No 
boilers whatever in or near asylum buildings. Tunnel connections 
for water, steam, electricity, etc. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sition where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas or 
oil? Electricity. 

22. Is the lighting controlled by fixed rules or how is it governed 
and regulated? Governed by electrical engineer. Telephone com- 
munication from office to entire group of buildings. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Yes; we have six. From 8.30 
P. M. to 6.30 A. M. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 
We have a main kitchen separated entirely from the asylum build- 
ings. In this kitchen all the cooking is done and the food when ready 
is placed on trucks and sent by underground tunnels to the asylum 
buildings. There is no cooking done anywhere else. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Within 
175 feet. Accessible at all hours. Kept in constant repair and al- 
ways ready. 

28. Have you telephone communications with any located fire ap- 
paratus? We have our own apparatus. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have please send copy of them. Yes. Five blows of 
power house whistle calls together our volunteer fire department, or- 
ganized by the male employes of the institution, Department is 
under control of the chief engineer. In addition the attendants on 
each ward are compelled at frequent intervals to take hose from 
racks and go through a regular fire drill. Thus they are prepared 
as to what to do in an emergency. On the grounds there are six fire 
hydrants with a pressue of 85 pounds to square inch. We are thus 
able to throw a stream of water over the tops of all our buildings. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 



60 

their character? No. None nearer than barns which are 1,000 feet 
away. \ . j 

31. Are the insane patients for which you receive State aid, kept in 
a separate building from the other patients? Describe the building 
in which they are kept, and if possible supply a photographic view 
of the same for use in the report of the Commission. Yes. The 
buildings are of brick and stone. They are of slow combustion, 
double flooring and fire proof stairways. Stairway is five feet with 
double doors five feet four inches by eight feet from vestibule and one 
double door from wards to vestibule five feet six inches by eight feet 
on each floor. 

Buildings are L shaped. In the male building the first floor where 
are housed our milder class of patients, is composed of a main hall 
into which open the sleeping rooms, bath rooms, closets, wash rooms 
and day rooms. The remaining wing is composed of a dining room, 
accommodating all patients and five furnished rooms with bath 
and toilet attachments for attendants. In the middle of the main 
hall is a large room occupied by the attendant in charge of the ward 
and one of his assistants. This room is occupied by these two at- 
tendants day and night causing them to be at hand for immediate call 
at any hour of the night should their services be suddenly required 
by the night attendants. The remainder of the day attendants oc- 
cupy at night the rooms before mentioned. The second floor is, on 
its main hall, identical with the first, consisting .of one large hall 
sixteen feet wide, into which open the sleeping rooms, bath rooms, 
wash rooms, closets and day rooms. The same arrangements as re- 
gards the attendants' room of the first floor is observed on all floors. 
The remaining wing on this floor is composed of a hall into which 
opens ten single rooms, of cement floor, arranged for violent and 
untidy patients. At the end of this short hall is a large dormitory 
in which thirty-eight patients, who are not troublesome, are per- 
mitted to sleep. Third floor, main hall, same. Remaining wing is 
composed of 34 single rooms, 24 of which are cemented and arranged 
for the care of violent and untidy patients. A large portion of this 
hall is also cemented to permit of thorough flushing and cleaning. 

The female building does not differ from the male except that in 
the male building the attendants' quarters and the large dormitory 
are additions to the original building and were not added to the fe- 
male building. The female attendants have their rooms on the wards. 



Remarks. 
The medical staff of the institution at present consists of C. W. 
Wilkin, physician-in-chief; J. D. Carr, Jr., assistant physician-in- 
chief; O. B. Schildecker, assistant resident physician. 



61 

The remaining employes of the institution consists of one drug- 
gist and hospital steward, one chief clerk, one assistant clerk, one 
head farmer, two assistant farmers, one gardener, one chief engineer 
with five assistants for day and night turns, one electrical engineer, 
one carpenter, two painters, two hospital nurses, one baker, one store- 
keeper, one supervisor, two matrons, one children's nurse, one super- 
visor of officers' dining rooms, one waitress in dining room of 
superintendent, three cooks and the attendants. 

The farm upon which the institution is located is in the Chartiers 
Valley, on line of Chartiers branch of the Pittsburgh, Cincinnati, 
Chicago and St. Louis Eailroad, and fourteen and eight-tenth miles 
from Pittsburgh. Two hundred and eighty acres of the farm are 
under cultivation and this work is done solely by our chronic male 
insane. A large number of our chronic male insane are employed 
in this manner, the patients being taken out in gangs by competent 
attendants. The intrinsic value of the labor thus produced by these 
patients is not so much of a. consideration to us as is the happy, 
healthy effect such employment produces on the minds of this par- 
ticular class of patients. Were not such patients given employ- 
ment many of them would become ugly and unruly whereas at pres- 
ent we rarely have the slighest trouble with our chronic insane. 
Many of the acute and subacute patients, who are not permitted to 
do farm work find employment in the buildings. We permit no pa- 
tients to be idle except the few unruly patients we have and the dis- 
abled. In the laundry thirty-five or forty chronic insane females are 
employed and here we find the same happy result obtaining in their 
mental and physical condition. A large number of insane females 
are constantly employed in the sewing room where they make all the 
garments used in the institution. We have the same experience 
with these patients. In the piggeries, about the barns, in the 
gardens, and about the greenhouses we have constantly employed 
numbers of insane patients and we have never had occasion to do 
otherwise than congratulate ourselves upon the genuine improve- 
ment such employment brings to the mentally afflicted. From five 
to six barrels of flour, used at the institution, are baked into bread 
daily by insane male patients, under the guidance of a skilled baker. 
These patients are cleanly and thorough in their work and the sever- 
est punishment to them would be to deprive them of the opportunity 
of going to their work. 

Our object has always been to furnish employment for every in- 
sane patient who is physically able. By our system here we find this 
can be done in the great majority of cases and if this practice were 
more generally carried out in our insane institutions I believe the 
proper caring for insane people would be greatly simplified. 

GEO. LINDERMAN, 

Superintendent. 



62 



SOMERSET COUNTY HOSPITAL FOR THE INSANE, SOMER- 
SET, PA. 






1. What number of insane inmates are in your care? 66. 

2. Males? 41. 

3. Females? 25. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? Four attendants; one 
cook and one engineer and laundry man. 

5. Are there any violent cases which require separate confine- 
ment? None permanently. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick, 

7. What is the width of the staircases connecting your different 
stories? Four and one-half feet front and three and one-half feet 
rear stairways. 

8. Are there front and back, or only single staircases? Two front 
and two rear stairways. 

9. Upon what floor or story are there sleeping rooms? (State the 
number on each floor.) Sleeping rooms on all floors. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 20 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? Three 
iron fire escapes, on outside doors open from large rooms to them. 

12. What is the size of the doors and windows opening from the in- 
terior into the fire escapes? Two feet six inches by six feet eight 
inches (all doors). 

13. How near do these fire escapes approach the ground? Extend 
to ground. 

14. Whence do you draw your water supply? From wells and 
springs to large tanks on attic of building. The water supply has 
been short owing to excessive drouth. 

15. What stories of your building are reached by water supply? 
What are the number and size of vents upon each floor? First and 
second stories. Inch pipes. 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) Two fire hose 
attached to tanks in attic. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? 50 feet of hose on each floor. 



63 

18. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? Heated by hot water system. 
Boilers not accessible to inmates, except those who help care for 
them. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
building? If not, where are they? The hot water heater is in the 
cellar. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sitions where the insane would have access to them? No. Only 
stoves in building is a range for cooking. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Electric light. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Switches. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil ? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Watchman up to 11 P. M. 
Attendants sleep on second floor. 

25. Do you allow smoking in the dormitories? No, except in case 
of aged persons. 

26. Are there any dormitories directly over the kitchen? Have no 
large dormitories, greatest number in any one room is four, never ex- 
ceeding six. Only one room over kitchen. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? Have 
no fire engines. 

28. Have you telephone communication with any' located fire ap- 
paratus? Have telephone but not connected to any fire depart- 
ment. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them? No rules. 

30. Are there any buildings of an inflammable character located 
near or adjoining your own? If near, at what distance, and what is 
their character? None closer than 100 feet. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic 
view of the same for use in the report of the Commission. Yes. A 
number of the patients, who are quiet and harmless and who work 
on the farm, occupy rooms in the almshouse, on the same farm and 
adjacent to the hospital. Permission was granted to board of di- 
rectors by Committee on Lunacy for them to occupy these rooms. 



64 

Will forward photographs to your Commission of buildings. There 
is no danger of fire whatever, in the Somerset County Hospital for 
the Insane, and even if fire should occur the ample means of escape 
from the building narrows all danger from loss of life by fire to a 
minimum. 

The inmates are well cared for, well housed and fed and enjoy good 
health. Only two deaths during the year. 

L. C. COLBORN, Treas., 
Somerset, Pa. 



WASHINGTON COUNTY HOME FOR THE INSANE, ARDEN, 

PENNA. 



1. What number of insane inmates are in your care? 30. 

2. Males? 15. 

3. Females? 15. 

4. How many attendants have you for the insane inmates, and 
what is the actual capacity of your buildings? (a) Two males; two 
females; (b) 50. 

5. Are there any violent cases which require separate confine- 
ment? No. 

6. Of what are your buildings constructed — frame, stone or brick? 
Brick and stone. 

7. What is the w T idth of the staircases connecting your different 
stories? 52 inches. 

8. Are there front and back, or only single staircases? Front 
and back also bridge to other wing. 

9. Upon what floor or story are there sleeping rooms? (State 
the number on each floor.) First floor, 8; second floor, 8; third 
floor, 32. 

10. What is the elevation above the ground of your highest sleep- 
ing apartments used for insane? 26 feet. 

11. Have you any outside fire escapes? If so, what stories do they 
reach, and how is access obtained to them from each floor? (a) Yes; 
(b) third story; (c) one window on each floor. 

12. What is the size of the doors and windows opening from the 
interior into the fire escapes? Windows 3x7 feet. 

13. How near do these fire escapes approach the ground? Rest on 
ground. 

14. Whence do you draw your water supply? From 10,000 barrel 
reservoir. 

15. What stories of your building are reached by water supply? 
What are the number and sizes of vents upon each floor? (a) All three 
stories, (b) Two stand pipes connected with three inch main in cel- 
lar with over 50 pounds pressure. 






Pi 

Q 



O 

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s 

£-1 



50 

or? 



P 
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sr 

rp 
P 

I 

td 

o 



W 

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o 





MS 











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ct- 
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65 

16. Have you any hose attachments upon any floor? (If so, how 
many, and what is the size of the discharge pipe?) Yes. Two on 
each floor; one and one-half inch. 

17. How many feet of hose have you ready for use upon each floor, 
and what is its size and length? Two on each floor, each one is one 
and one-half inches. 120 feet long. 

IS. How are your buildings heated? If heated by steam, are the 
boilers accessible to the insane? (a) By steam, (b) Boilers not ac- 
cessible. 

19. If heated by steam, are the boilers within the main buildings? 
Are there any boilers for heating or manufacturing within the main 
building? If not, where are they? (a) None in building, (b) In 
separate building adjoining main building on east. 

20. Are there any anthracite or bituminous stoves or grates in po- 
sitions where the insane would have access to them? No. 

21. Are your buildings lighted with electricity, illuminating gas 
or oil? Gas. 

22. Is the lighting controlled by fixed rules, or how is it governed 
and regulated? Fixed rules. 

23. Do the insane have access to the control and supply of light, 
whether by gas or oil? No. 

24. Have you watchmen at night upon the sleeping floors? If so, 
how many, and between what hours? Two from 9 P. M. to 6 A. M. 

25. Do you allow smoking in the dormitories? No. 

26. Are there any dormitories directly over the kitchen? No. 

27. How near to the buildings are the nearest fire engines, whether 
public or private, and are they accessible in an emergency? None 
accessible. 

28. Have you telephone communication with any located fire ap- 
paratus? No. 

29. Have you any established rules in case of an alarm of fire, or 
have you any organized or printed methods to pursue in case of 
alarm? If you have, please send copy of them. . 

30. Are there any buildings of an inflammable character near or 
adjoining your own? If near, at what distance, and what is their 
character? (a) Laundry building, (b) Two-story frame 20x30 feet, 
20 feet from building. 

31. Are the insane patients for which you receive State aid, kept 
in a separate building from the other patients? Describe the build- 
ing in which they are kept, and if possible supply a photographic view 
of the same for use in the report of the Commission. No. We send 
by this mail a plan of second floor of the home. First and third 
floors are same as second, only that third floors are larger rooms; no 
cells. Dining room under chapel. This with a view of the building 
will, we think, give a fairly good idea of the arrangement. 

5 




(W) 



LEGISLATIVE COMMISSION TO INQUIRE INTO THE CONDITION 
OF PENNSYLVANIA INSANE. 



REPORT 



OF THE 



SUB-COMMITTEE 



TO 



OBTAIN THE VIEWS OF EXPERIENCED OFFICIALS 
MANAGING THE INSANE. 



WM. T. MARSHALL, Chairman. 
FRANK B. McCLAIN. 
JOHN M. SCOTT. 



(67) 




(68) 



REPORT OF THE SUB COMMITTEE TO OBTAIN THE VIEWS 
OF EXPERIENCED OFFICIALS MANAGING THE INSANE. 



To the Legislative Commission to Investigate the Condition of Penn- 
sylvania Insane: 

Gentlemen : At a meeting held on October 8, 1901, of the Joint 
Committee to Investigate the Condition of the Pennsylvania In- 
sane, a resolution was offered by Mr. W. 0. Sproul, appointing a 
sub-committee to obtain the official views of experienced superin- 
tendents, physicians and officers as to any improved method of 
government or economy. 

In accordance with such resolution the undersigned (being the 
sub-committee), beg leave to submit the following report: 

On March 5, 1902, they gave a formal notice to the superintend- 
ents in charge of the State and county institutions, having care of 
the insane, to appear before the committee at a meeting to be held 
in Philadelphia, on Tuesday, May 6th, at 10 o'clock A. M. in Court 
Room No. 646, City Hall. It was deemed best for the superintend- 
ents to be directed to appear before the entire committee (instead 
of merely the sub-committee) in order that there might be full 
publicity and an opportunity afforded to each member of the com- 
mittee to ask any question which he might deem expedient. 

The superintendents were notified that the subjects to be consid- 
ered were of vital interest to themselves and the inmates of their 
institutions and they were called upon either for a personal attend- 
ance or for a paper embodying a statement of the condition of 
their wards and suggestions upon their care and management. At 
the time and place designated there appeared superintendents or 
reports from all the State institutions except the Wernersville 
asylum, >S. S. Hill, M. D., superintendent, who was prevented from 
leaving home on account of the illness in his family, and the State 
Hospital for Insane at Danville, the superintendent of which, H. B. 
Meredith, M. D., announced that he would be unable to be present 
on account of small-pox being in his institution. 

(Note by Secretary.) Both of these institutions were afterwards 
visited by the full committee. 

Nine county institutions were represented by their directors or 

(69) 



TO 

superintendents and seven county hospitals and almshouses failed 
to send any representatives. 

Inasmuch as the testimony taken on May 6th and Tth is of such a 
character that even its minor deails are of interest it is herewith 
embodied in full and made a portion of the report of your sub- 
committee. 

Very respectfully submitted, 

W. T. MARSHALL, Chairman, 
F. B. McCLAIN, 
JOHN M. SCOTT. 



71 



PROCEEDINGS OF THE LEGISLATIVE COMMISSION WHICH 
CONVENED IN COURT ROOM NO. 5, IN THE CITY OF PHILA- 
DELPHIA, ON TUESDAY, MAY 6, 1902, AT 10 O'CLOCK A. M. 



The commission was called to order by Hon. William P. Snyder, 
chairman. 

Mr. Snyder. The Legislature of Pennsylvania, realizing that the 
present crowded condition of hospitals for the care and treatment 
of the insane required the early necessity of accommodation for 
the increased number of patients, authorized the appointment of 
three members of the Senate and four members of the House of Rep- 
resentatives, together with the President pro tern, of the Senate 
and Speaker of the House as ex-officio members, to make inquiry and 
report to the next Legislature some established basis which will 
afford the most modern and approved methods of treatment and the 
greatest amount of comfort and freedom compatible with their con- 
dition. 

■Some of our sister states have established a system whereby under 
gentle surveillance and kindly treatment the lunatics are found 
occupation for mind and body and in place of being wholly charges 
upon the state and life a burden to them, they become successful 
tillers of the soil, skilled artisans and mechanical constructors in 
many ways. One of the most successful of these institutions is the 
Willard State Hospital for the Insane of New York. 

It is not the purpose of this committee to enter upon their duties 
with the belief that flagrant violations of the present laws exist iu 
all state institutions, but to inquire of the superintendents, physi- 
cians and officers, their experience as to any improved methods of 
government or economy, as to the advisability of affording the in- 
mates light employment, to the physical condition of the buildings 
with regard to fire and means of escape in case of fire, the means at 
command during contagious epidemics, the experience and advisa- 
bility of establishing county institutions, the cost and maintenance 
of both state and county hospitals, and such other information as 
is necessary, and also to correct any existing deficiency in institu- 
tions established under our present laws and to make a report to 
the next Legislature and present such remedial legislation, if neces- 
sary, as will ameliorate and protect the lives of the insane of this 
great State. 



72 

Of the superintendents, who are present of the seven State hos- 
pitals for the insane, the superintendents will be heard according 
to their seniority. 

The first on the list is the Pennsylvania State Lunatic Hospital 
at Harrisburg. Dr. Orth was here yesterday and informed us that 
he could not be here before to-morrow. 

The next hospital, ranking in seniority, is the Western Pennsyl- 
vania Hospital for the Insane, at Dixmont, in Allegheny county. 
Dr. H. A. Hutchinson, superintendent. 



Dr. H. A. Hutchinson called and testified as follows: 
Examination conducted by Mr. Snyder, Chairman. 

Q. With regard to the question of food, are the inmates of your 
institution being fed in the best ways, in the ways that are most 
advantageous for them and most economical for the taxpayer? Can 
you suggest any ways to improve the diet and diminish the cost? 

A. I do not see how we can produce supplies at any less cost 
than we are doing in our hospital under our present plan. We have 
a very liberal dietary, one of the most liberal that I know of. The 
patients are well fed and have a great abundance of everything on 
the table in season and I do not see, if we are going to keep up 
that standard, how we can decrease the cost. The purchases are 
made with the greatest care; the purchasing agent is a most com- 
petent and most thorough man in that respect and I don't see how 
we can replace our system by anything that is better. 

Q. What method have you adopted in obtaining employes whom 
you know are fit or qualified to attend the insane? 

A. My method of obtaining employes is simply this for the women 
employes : I require a letter of recommendation from their pastor, 
from their family physician and from a well qualified citizen whom 
they know. They must present those three letters. In addition to 
that they have to answer a blank form and I send all blanks there 
which contain a long list of questions as to their age, state of health, 
what church they belong to, what experience they have and if they 
have any environments or are likely to have any. Those questions 
are included in that blank. 

Q. Have you a copy with you? 

A. No, sir; I have not. 

Q. Will you furnish one to the secretary? 

A. I will take great pleasure in mailing one when I get home. If 
I had known you wanted it I would have brought it with me. 

Q. Do you exact from them a proper consideration for the mental 



73 

defects of the patients with whom they deal; in other words, are 
they educated up to the mental and physical requirements of their 
position, or are they simply able to enforce order by the employment 
of absolute force? 

A. I prefer to employ everybody who has had no experience in 
hospital work. We have a training school for nurses at the insti- 
tution, which is conducted on a business plan. It is cold in its 
management; there are no favors shown in it and we give training 
there and 1 always consider that after they have been there a few 
months they begin to be of value to the institution. I do not lik,e 
to have employes come there that have had experience in other in- 
stitutions because I like to break them in to suit our own individual 
institution. My opinion is that that has always been more success- 
ful with us. 

Q. How are your supplies obtained for the use of your hospital, by 
public bids, by competition, by regular contract, or in what manner? 

A. We buy everything in competition; we don't buy five cents 
worth of anything over the 'phone but everything is purchased by 
competition. 

Q. What provision have you made for inspecting the supplies, 
whether food or otherwise, to ascertain whether they conform to 
the stipulations under which they were obtained, both as to quality 
and quantity and price? 

A. The purchasing agent has a written order from me to buy 
such and such commodity and he goes and gets bids on it and reports 
to me the kind and quality and if necessary samples are provided 
and then the purchase is made as we see fit. 

Q. Are they advertised? 

A. No, sir; we used to do that years ago but we don't do it any 
more because we think this plan is better. 

Q. The purchasing agent inspects the supplies as they are pur- 
chased to see whether they are up to the standard? 

A. Yes, sir; and they are not accepted unless they are approved 
by myself. 

Q. Do you find any advantage in not obtaining your supplies from 
some central source? 

A. Yes, sir; because under our system the quality is taken into 
consideration and we have a better opportunity of judging of it 
individually and therefore we think our present policy is the best 
plan. 

Q. What is the average proportion numerically of your attendants 
to the number of your inmates, that is, those that are actually in 
contact with the insane and responsible for their care and keeping? 

A. I think it is about one to ten. I think the law requires that. 



74 

Q. Tnose are the ones actually in contact with the insane? 

A. Yes, sir. 

Q. And take charge of them? 

A. Yes, sir. 

Q. What are the requirements of admission, under existing law, 
for a patient in your institution? 

A. They can be admitted there in three ways: By request of 
their friends, by request of the poor authorities upon the certificates 
of two physicians and by order of the court. 

• Q. What is the source of your water supply for drinking pur- 
poses? 

A. We have the very best water supply in the State. We have 
a pumping apparatus that pumps river water up into a reservoir 
and from that taken into the institution. It is filtered and is as 
clear as spring water and we use that for all house cleaning and 
general purpose use. For drinking water and cooking we have any 
quantity of spring water. 

Q. What provision has been made for the sewage of your institu- 
tion? 

A. The same way as to sewers. We have large sewers which run 
down the hill and empty into the Ohio river and run into the intake 
a piece; and that is the way we get rid of it and we feel confident that 
we have a splendid plan. 

Q. How is your building heated? 

A. By steam. 

Q. Have you any suggestions to make that would improve the 
manner of heating your buildings? 

A. No, sir; our buildings are always nice and warm and very 
comfortable. In fact to a man w T ho is in good health it is too warm 
because it is kept warmer than necessary on account of the large 
number of old people. Sometimes heat is a burden. 

Q. What attention have you paid to the ventilation of the living 
and sleeping apartments? 

A. We have no system of ventilation. I have an old building 
and therefore we have no system of ventilation. We ventilate 
through the windows and doors. We have fans in the cellar but 
I don't attach much importance to them. The ventilation is, how- 
ever, very good. 

Q. Is it direct or indirect steam radiation? 

A. It is a direct system right into the heaters; in fact it is by both. 
We have the heaters in the cellar and have steam heaters in some 
of the wards. 

Q. Is there any systematic method of inquiry into the state of 
health of your patients at any stated time and, if so, how frequently 
and in what manner is the inquiry conducted? 



75 

A. Who do you mean? 

Q. How often do the physicians visit the patient? 

A. The rule at my hospital is that the resident physicians visit 
the patients twice a day. I know it to be a fact that the physicians 
there visit the patients as many as three and four and five times 
a day. I am in my own wards two and three times a day always 
when I am home and well. 

Q. Are there any women managers of your institution? 

A. We have one or two women on the board but none directly 
concerned with my institution. 

Q. Do you not believe that if the practice was adopted, as is the 
case with the Utica State Hospital for Lunacy in New York and 
with other New York hospitals, of placing women upon the board 
of managers that the result would be advantageous? 

A. We are getting along very well as it is now. 

Q. How many visits have the managers of your institution paid 
to it during the last year? 

A. I have an executive committee composed of ten members, some 
of them are there every week; they are not all there but some of 
them. They telephone down to me sometimes once a day and som- 
tims twice a day to know how I am getting along and also have a 
meeting on the second Tuesday of every month at which sometimes 
all are present. They are down there frequently, not strictly in 
an official capacity but they come down to see me and sit awhile 
and visit the wards and visit me and then they go away. 

Q. How often do you have stated meetings? 

A. Have a stated meeting every week. 

Q. Do the managers at those times make an inspection and in- 
vestigation of those departments? 

A. Yes, sir; very carefully so. 

Q. Have you women nurses and women attendants in the women's 
department? 

A. Yes, sir. 

Q. What proportion do they bear numerically to the number of 
patients? 

A. About the same, one to ten. 

Q. Do you think that if the supplies for your institution were fur- 
nished from some central source, such as the prisons of the State, 
that it would be a saving to the taxpayers? 

A. Not in the manner we are doing. 

Q. How are your buildings lighted? 

A. By gas at present. We are seriously contemplating, and will 
as soon as possible, put in electric light. 

Q. What are your rules governing absentees among officers and 
what are the hours numerically of your nurses and attendants? 



A. My assistant physicians, I allow them to go away at any rea- 
sonable time. They always come to me and let me know that they 
would like to go away and if it is convenient to me I permit them 
to do so. It is the same way with the subordinates; they go to the 
heads of their respective departments and obtain leave of absence 
from them. 

Q. How many hours are they on duty out of the twenty-four? 

A. It would be hard to answer that question. They are on duty 
until late at night; they are in their wards at 10, 11 and 12 o'clock 
at night, that is, the physicians. The supervisor in the male and 
female departments is on from 6 o'clock until about 9 o'clock at 
night; they go to bed about 10 o'clock. The nurses all over the 
hospital are supposed to be in bed by 10 o'clock and arise at 6 o'clock 
in the morning. 

Q. They are relieved by other nurses or watchmen in the wards? 

A. Xo, sir; the patients are put to bed, of course, according to 
their mental condition and their physical condition between 7 and 
9 o'clock. Some of the nurses are practically off duty a little earlier 
although not in bed until 10 o'clock. Night nurses go on duty at 
8 o'clock. The physicians are practically on duty all the time. 

Q. How many patients have you? 

A. Eight hundred and five at the present time. 

Q. In the male and female wards? 

A. Yes, sir. 

Q. How many of those are public patients? 

A. About seven hundred. 

Q. And the balance are private patients? 

A. Yes, sir. 

Q. What are your rates, per week, for the respective classes? 

A. For the indigent insane we receive $3.75 per week; for the pri- 
vate patients the lowest rate is $7.50 per week. 

Q. Do you place restrictions upon communication by letter to or 
from your patients? 

A. The letter writing in the hospital is controlled by the lunacy 
law as near as possible. A patient is supposed to write one letter 
a week, letters to attorneys and anything that the law permits 
are allowed to go and other letters, according to the rules of the 
Board of Charity, are always inspected by an officer detailed for that 
work. 

Q. In your judgment, should there not be uniform regulations 
for all hospitals in regard to correspondence of the insane? 

A. I think it is now, as far as I know. 

Q. Not deviated from? 

A. No, sir. 



77 

Q. Do you approve of the provision of the law of the state of New 
York, that the insane shall be allowed to correspond without restric- 
tion with the county judge and district attorney of the county from 
which they were committed; would that be an advantage? 

A. Practically the same right pertains to these hospitals now; 
as I understand they do the same thing now, as I understand it. 
We allow that at home. 

Q. How often does the Committee on Lunacy of the Board of 
Public Charities visit your institution, how often did they visit your 
institution last year? 

A. They visited quite frequently, the Board of Lunacy, or their 
representative, or members of the Board, were there sometimes 
three and four times, and sometimes four and five times — lately 
sometimes four and five times. 

Q. More than one member of the Board? . 

A. Yes, sir; sometimes two, sometimes three and sometimes four. 

Q. Have you any inmates in your institution with reference to 
whom you or your medical faculty entertain any doubt as to actual 
insanity? 

A. No, sir. 

Q. Have you any suggestions or recommendations to make with 
regard to the laws governing the admission of inmates, or making 
any change in the present laws? 

A. It is a question I have not thought very much about but I 
think the laws are very good with respect to the admission of 
patients to the hospitals in this State. 

Q. Have you noticed any abuses that have occurred since the in- 
troduction of this system? 

A. No, sir. 

Q. Is the line of demarcation tightly drawn between the male 
and female inmates, as to social life? 

A. Very much so at Dixmont. 

Q. Is the line also drawn between the cases of acute insane and 
those of other classes? 

A. Yes, sir; it is classified according to scientific classification 
all over the house. 

Q. What formula is adopted to obtain the discharge of a patient 
in your institution? 

A. That is also controlled by the lunacy law of this State. Pa- 
tients committed by the court require an order from the court for 
their release. Patients committed by the poor authorities, in that 
case I always communicate with the poor authorities and tell them 
that such and such a patient is restored, or very much improved 
and might be benefited by going home and they come after them. 
The same way is adopted with reference to private patients. 



78 

Q. I understand the Auditor General requires the different State 
institutions to have a uniform system of book-keeping and some 
uniform method of obtaining supplies to be provided and some gen- 
eral concert of action to be adopted; how does that work? 

A. I think we have the prescribed form of book-keeping there. 
We have the voucher system and I think it perfectly satisfactory. 
It is very clear that it is for the reason that the inspector of the 
Auditor General's department is there from time to time and 
he reports to me that it is most satisfactory to him. That is all 
I want. He is always very careful to tell me he approves of such 
and such things. Once in a while where he has any suggestion to 
make he makes it and we endeavor to carry it out. 

Q. How often does the representative of the Auditor General's 
department visit you? 

A. I think he is there about every three months. 

Q. Might not a conference of superintendents prescribe a system 
of uniform blanks which would imply, if it did not compel, a sub- 
stantial uniformity of methods in administering the affairs of all the 
hospitals? In other words, would it be advantageous for the super- 
intendents to have a conference frequently, three or four times a 
year, or half a dozen times a year? 

A. That might be of advantage. It is a question that I have not 
given much thought to. I am in frequent correspondence with the 
superintendents about matters and affairs. 

Q. What provision has been made in your hospital in case of an 
outbreak of any contagious or infectious disease? 

A. I think we are very well provided; I have a frame building 
that I had the managers build up on the hill, remote from the insti- 
tution. I had it built one story high and in case it becomes infected 
it could be destroyed without much loss. It is used at the present 
time by a lot of demented patients but they could be easily removed 
should we have any acute infectious disease. I have also another 
similar building for the women patients under the same circum- 
stances. 

Q. Have you any contagious or infectious diseases there at the 
present time? 

A. We have a small epidemic of measles there at this time. 

Q. Have you any serious attacks? 

A. No, sir; except that they make an adult patient more serious 
than a child. 

Q. Do you place them out of the institution? 

A. Yes, sir; I remember some years ago we had an epidemic in 
the laundry department and they were isolated without any great 
detriment to the institution. 



79 

Q. What is your system of religious observance? 

A. It has always been the custom of the hospital to have ministers 
of the Gospel of the various denominations to come and hold ser- 
vices. We have services every afternoon. Sometimes we get better 
preaching than others. 

Q. What is your formula by which you transfer patients from 
your institution to that of any particular county, what are the 
requirements and whose assent is necessary for such transfer? 

A. The lunacy law controls that entirely; it is done entirely by 
it. It requires the usual order of transfer in duplicate, one copy 
to me and one to the superintendent to which the patient is to be 
transferred and it also requires a copy of the original certificate of 
the physicians. 

Q. Do you believe that so far as it is possible the application of 
correct civil service principles for the employment in the various 
hospitals would be beneficial? This civil service, as you are prob- 
ably aware, already exists in the state of New York with regard to 
the insane hospitals? 

A. I don't know that it is any such great success there, that it 
need be established here. 

Q. You don't think you would get any better results, if adopted, 
than under your present system? 

A. No, sir; I don't think so, not with the careful manner in which 
we employ subordinates, about which I have detailed to you. 

Q. Have you any suggestions to make as to the means of pre- 
venting insanity, embracing such points as the inordinate use of 
alcohol and tobacco, the enervating life of cities and the disease of 
heredity, or from other causes? 

A. That is a pretty hard question to answer, Mr. Chairman. I am 
of the opinion that likely since there are a great many patients in 
institution of this kind, it has a tendency to break down their 
health, breaks down their mental faculties and results in insanity; 
if it could be prevented we would not have so many insane. 

Q. How are the superintendents, the stewards and matrons ap- 
pointed in your institution? 

A. The superintendent is appointed by the board. The physi- 
cians are appointed by me and confirmed by the executive committee 
and the subordinate officers in the institution are appointed by 
myself. 

Q. Does the superintendent have the sole and discretionary 
power in employing and discharging employes? 

A. I have charge of all subordinate persons in the matter of dis- 
charge as well as of the assistant physicians; howeyer ? that nu 
pleasant $utv J neyer had to perform* 



80 

Q. In New York state the superintendents are required to meet 
every two months to discuss matters concerning the general wel- 
fare. Do you think that such meeting in Pennsylvania would be 
beneficial? 

A. It might result in good; I don't know. It might be the means 
of doing good. 

Q. In what manner are inmates transferred from the State insti- 
tution to the county institution? 

A. In the manner in which I told you a few minutes ago. 

Q. Just detail the manner required under the act of Assembly 
by which patients are transferred from your institution to the county 
institution? 

A. The way it is done is simply this: The superintendent of the 
institution having an insane department, in connection with the 
county home, notifies me usually by letter that he would like to 
transfer, say a number of patients and generally comes to see me 
and we discuss as to the proper patients to be transferred. I always 
carefully aim to furnish him with a true history of the patients, so 
he can take proper care of the patient; should the patient be of a 
suicidal, homicidal tendency, or something of that kind; and after 
he obtains that he applies for an order of transfer and that is ac- 
companied by a copy of the physician's original certificate admitting 
them in Dixmont. 

Q. The law requires that a female patient be accompanied by 
another female. Is there any such rule or system in force in your 
transfers? 

A. Since the penalty has been attached it has been enforced. 

Q. How about the operation of the law? 

A. It is a very good law. 

Q. How about the transfer of the minors? 

A. The same holds true. 

Q. Dixmont is a corporation? 

A. Yes, sir. 

Q. What are the relations of your institution with this State? 

A. For a number of years the institution there received appro- 
priations from time to time for the keeping of the indigent insane. 
For the last sixteen years the hospital has received no distinct ap- 
propriation at all; in the meantime we have had indigent insane 
there and received merely a pro rata per week, that the law pro- 
vides in such cases. 

Mr. Snyder. Has any member of the committee any questions 
to ask? 

Q. (By Mr. Sproul.) I would like to ask whether there are in your 
institution a large proportion of curable patients? 




be 

^5 



X 



X 





State Hospital for Insane — Dixmont — Women's Ward. 




X 



81 

A. To answer that in a broad sense, I would say, that we regard 
a majority of them as being curable. You mean are they recover- 
able? 

Q. Yes, sir. 

A. The forms of insanity have very much changed in recent 
years; we do not get the cases now of insanity, that recover, like 
we used to. 

Q. They go more largely to training schools than formerly? 

A. No, sir; it is due to the change of the times and the different 
manner of living and various things. We don't get the forms of 
acute mania and acute melancholia that we formerly did. Emigra- 
tion is different now and we have a larger number of Slavs and 
Hungarians that won't get well when sent to our institutions as 
usual, therefore we have not as large a proportion of patients get 
well. 

Q. Have you any system of training for those not hopelessly 
insane and that you deem recoverable? 

A. The hospital that I represent presents a very large field of 
resources for the employment and occupation which enters so 
largely into the curative measures and the treatment of its insane. 

Q. You have cases then where inmates are discharged as cured? 

A. Yes, sir; we discharge about a hundred every year. 

Q. (By Mr. Bliss.) What is your judgment as to the policy of 
the separate care of the chronic insane? 

A. I have never approved of that very much; for taking the senti- 
mental part of it I don't believe in branding every patient as incur- 
able by committing him to an institution the insane know that is 
incurable for the chronic; therefore, from that standpoint, I never 
approved of it. It was tried in New York and was not feasible; 
I do not believe it is a good plan. I am not making any criticism 
with respect to the usages at any of the institutions of this State 
because I think it is wisely done. 

Q. Do you think it would be wise or not to take a new departure? 

A. I would not increase the facilities of that institution if I had 
anything to do with it and I think it is not a good departure. I 
think it is a backward move. 

Q. What is your judgment of the system of county care of the 
insane ? 

A. Where the county care is conducted on a broad plane, like 
some of the institutions of this State, I imagine it is very good, but 
where it is conducted with little care in attendance, like it is at 
some of the county homes, I would not approve of it. 

Q. In other words, you think it would be advantageous if there 
were some general system of supervision? 

6 



82 

A. I think common sense teaches us that those patients, in such 
institutions, would get better care. 

Q. What is your judgment as to the wisdom of the separate care 
of those who are acquitted of crime on account of insanity and placed 
in an insane institution? 

A. I feel very pronounced on that point; I think it is a great 
wrong in this age to make a jailor out of any insane hospital for the 
reason that I think they should be placed in an institution separate 
and apart by themselves. I have about thirty-four down tnere who 
are a menace to the happiness and disipline of that institution and 
I think it is an outrage that they should be kept there. I think the 
State should make a separate institution for them. 

Q. Are you acquainted with an institution of that kind in New 
York State? 

A. I know there are such institutions throughout the country but 
I can't speak, specially, of the one in New York for the reason that 
I do not know about it. 

Q. What system have you in your institution for keeping a record 
of complaints, where they are made by the inmates of your insti- 
tution, have you any? 

A. Yes, sir; we have a very good system. We have printed blanks 
that the head nurses in the ward has to make a report of everything 
that transpires during the day to the physician having charge of 
that department. 

Q. Can a patient make a complaint? 

A. On the part of the patient, if the patient has any complaint 
to make they have free access to either myself or the assistant 
physician. 

Q. Are the complaints recorded? 

A. They are always listened to and investigated carefully and 
followed up carefully. 

Q. Explain what your system of investigation is? 

A. We always go to the patient. For instance, he complains that 
he has been struck by an attendant or by another patient and we 
always go to the patient and examine him and question him whether 
it happened and how it happened and if a nurse is involved we go 
to him and question him closely. 

Q. Do you mean yourself, you say "we?" 

A. Myself and the assistants. That is the plan we follow out. 

Q. You have no regular board to which you refer these com- 
plaints? 

A. No, sir; that is not necessary, we do that ourselves. 

Q. You say that letters are written by the patients to outsiders 
and that they are inspected by some one else outside of you? 



83 

A. I always have one of my assistants detailed for the purpose 
of having the mail pass through his hands. 

Q. What is the purpose of that? 

A. A great many of the insane write letters that would not be fit 
to go through the mail because a great many are filthy and vulgar 
and you have to have some control over such. 

Q. It is not for the purpose of preventing complaints going to 
persons outside? 

A. No, sir; not at all. 

Q. (By Mr. Hall.) In. speaking about the application of correct 
civil service principles for the employment in the various hospitals, 
you say you don't think it would work very well. Is that not more 
from the fact that attendants in some asylums must be selected 
more as a matter of temper? 

A. It is under the present circumstances. Under the present 
cirsumstances it would be pretty hard to work it practically because 
there are so many frequent changes in the corps of nurses. Times 
are so good now that it is hard to keep men and they frequently 
change. That is one of the annoyances that a hospital like the one 
over which I am superintendent has to put up with. 

Q. Wouldn't it be very difficult to get up any system of exami- 
nation to tell whether a m*an would be fit on the subject for which 
it is intended to make use of him as a nurse? 

A. I try to ascertain all that in the manner in which I have 
detailed it to the chairman and that is about as far as I can go. It 
is carried out as carefully as possible in our institution. 

Q. You think their fitness is better determined by your method 
and that you would actually learn more from them in that way 
than by any previous examination? 

A. Yes, sir; as I often tell them, if they are not suited to the 
work, no matter what letters of recommendation or blanks they 
fill out, I don't want them and will not keep them. 

Q. What do you think of sending the insane to the county hos- 
pital in a general way? 

A. I have no recommendation to make on that plan. I think 
where the insane department, for instance take the Allegheny Home, 
where they have a nice fine building and regularly appointed resi- 
dent physicians, who live there and stay there, I think it works very 
well. 

Q. In the average county homes or poorhouses, in the rural coun- 
ties, do you think they have proper arrangement and appliances for 
their care? 

A. I would prefer if a patient would be treated in a hospital. 

Q. What classes of patients are usually transferred, those who 
are incurable or who are curable? 



84 

A. Most of those who have been transferred to those almshouses 
have been of the incurable class. 

Q. For instance, if you take an insane person, are they alive to the 
comforts surrounding them, where they are comfortable, are they 
keen to see that? 

A. It is my idea that the insane know and appreciate a great 
deal more than the average layman and more than the ordinary 
observer would expect them to do. 

Q. Does not their condition of mind make it possible and is not 
such condition of mind liable to make them notice a slight, or ill- 
treatment? 

A. Those questions are controlled largely by their delusions, very 
largely so. 

Q. It might aggravate it? 

A. It is for that reason they are sensitive; that is one reason they 
are sensitive and that I don't favor institutions for the chronic in- 
sane. I think it is rather cruel to call them chronic. I think they 
feel they are incurable and have no hope. I make no reflection on 
the chronic insane but I would not want to see any other way 
adopted. 

Q. Is there anything to hamper the work? 

A. No, sir; there are some things happen in institutions of this 
character that is hard to overcome. For instance, these frequent 
changes of attendants; as long as attendants are employed, and 
especially young men, it is natural for them to suppose they can 
be employed in higher occupations and they will leave to engage 
in some other occupation. That is one of the difficulties you have 
to encounter; that is one of the unpleasant features and I wish it 
could be overcome but I see no other way at present. 

Q. Can the superintendents of the county almshouses select the 
patients to be taken there? 

A. No, sir; they generally do that themselves. When they come 
to my hospital and want to select a number of patients there are 
some I would not allow to be taken if I could help it; and in some 
cases where an outsider would take patients I would warn them 
or tell them that those persons had those delusions with which 
they are afflicted, and then if they take them they would have to 
assume the responsibility? 

Q. You could not prevent them from taking them? 

A. No, sir; I am always careful to impress that upon them and 
give them a history of the case so that they may be responsible for 
the care of the patient. 

Q. (By Mr. McClain.) Have you ample accommodation for all the 
patients you have in your institution? 






85 

A. No, sir; it is very much crowded. The hospital is a very popu 
lar one, as I suppose all the hospitals in the State are. There are 
applications coming in all the time, repeatedly, and we have more 
patients than we can accommodate. It is crowded and has been for 
years. 

Q. Would you increase its size? 

A. I would not want to see the hospital made any larger. I 
think it is plenty large enough and I think one good plan would be 
to build another congregate hospital. I understand there is a com- 
mission or there is a project for the building of a homoeopathic 
institution; if it is a congregate hospital I think it would be most 
acceptable to the State. 

Q. Which, in your opinion, would be the better policy for the 
State to pursue, the erection of a few more hospitals, or increasing 
the capacity of those already in existence, in order to relieve this 
congested condition? 

A. I would prefer the building of a new hospital. Mine is large 
enough; it keeps me busy enough to be in touch with all the patients 
in my institution and especially so where one wants to be conscien- 
tious in the performance of his duties. I think Dixmont is plenty 
large enough. 

Q. Your hospital is not distinctly a State institution? 

A. No, sir. 

Q. I understand your cost per week is $4.65 for each patient and 
that at the hospital for the chronic insane, located at Weraersville, 
it is $2.06, less than one-half the amount charged at your institu- 
tion; how do you explain that difference? 

A. T can't explain anything of that kind on the part of the other in- 
stitution. I can remember my own and that is based on a total cost 
of maintenance, which includes maintenance, repairs and every- 
thing. Of course it must be taken into consideration that Dixmont 
is an old institution and the repairs are, of necessity, large and that 
estimate is based on the total cost. 

Q. Would that include everything? 

A. Yes, sir. 

Q. (By Mr. Hall.) According to that the indigent insane cost more 
than you receive? 

A. Yes, sir. 

Q. You receive $3.75 for their care? 

A. Yes, sir. 

Q. And $4.65 is the actual cost? 

A. Yes, sir; they get the benefit of it, Mr. Hall. 

Q. (By Mr. McClain.) The difference is made up by the endow- 
ment? 



86 

A. That is what I say, they get the benefit of it. 

Q. (By Mr. Sproul.) You have other income? 

A. Yes, sir; from the private patients. 

Q. Have you no funds? 

A. We have one or two endowment funds. 

Q. (By Mr. McClain.) Does every private patient receive the same 
treatment that the indigent insane patient receives? 

A. Yes, sir; identically the same as the man who pays seven dollars 
a week, or if he would pay ten dollars a week. 

Q. (By Mr. Sproul.) Why is there a difference in the rate, is it 
because there are different accommodations? 

A. A great many people want patients there that don't want them 
as a charge on the State and we have these rules fixed, that if they 
want to admit private patients we have a rate fixed at which they 
can be received. 

Q. There is no variation in the price? 

A. Yes, from $7.50 up. Of course if a man wants a private at- 
tendant he will have to pay for it. If he wants special meals he 
will have to pay for it; I don't encourage that very much and that 
is the reason the indigent insane are treated the same as private 
patients and I do not like to make a difference because the insane 
do not appreciate the difference and if there was a difference they 
would see it and therefore we treat all alike. Nobody knows the 
difference between the indigent insane and the private patients 
except myself and the clerk. 

Q. Have you any suggestions or recommendations to make with 
reference to changing our present laws concerning the insane hos- 
pitals of the State and the care and treatment of the insane? 

A. We will make one or two, if you will allow it. 

Q. We will be glad to hear it. 

A. I think that the advanced prices of commodities has resulted 
in making $3.75 per week too little. I think the State might pro- 
vide better accommodations by the erection of another hospital 
and I think the attendants should be paid more. I think $3.75 
allows the hospitals to pay too little for the service of attendants 
and I think the attendants should be paid more and they would 
be more likely to remain in institutions of this character and thereby 
become more fitted for their work and would not be so likely to 
seek other positions where they receive more pay. 

Q. (By Mr. Bliss.) What do you pay your attendants? 

A. We pay men attendants $20 per month when they come there, 
including their board and washing. After they are there three 
months we pay them $22 and run them on up, as they become effi- 
cient, to $24, $25 and $27, and night nurses $30. On the women side 
they start in at $14, $16 and $20. 






87 

Q. If you built a new hospital to what number do you think it 
ought to be limited? 

A. For the good of the patients I think it ought to be limited 
to one thousand because the more liberal you treat them the more 
recoveries you will have. The more the physicians come in contact 
with the patients the more recoveries you will have. 

Q. (By Mr. Sproul). Wouldn't it be your judgment that in estab- 
lishing a few State institutions that those who are known as com- 
monly incurable and absolutely insane should be placed in sepa- 
rate institutions? 

A. That is a question that some argue for and some against. We 
have the acute and chronic, and others there, classed together and 
I myself think that is the better plan. 



Mr. Snyder, Chairman. The next to be heard is the State Hospital 
for the Insane, at Danville. Dr. H. B. Meredith, superintendent. 

Mr. Snyder. Dr. Meredith not being present, the next in order 
is the State Hospital for the Insane, at Warren. Dr. Morris S. Guth, 
superintendent, who is now called. 

Dr. Morris S. Guth called and testified as follows : 

Examination conducted by Mr. Snyder, chairman. 

Q. How are your supplies obtained for the use of your hospital, 
by public bids, by competition, by regular contract or in what 
manner ? 

A. By quarterly contract and they are gone over by a committee 
of the trustees who attend to that matter entirely in connection 
with the steward of the hospital. 

Q. Are the supplies advertised for and competitive bids sought? 

A. Not now because we send out certain blanks before this meet- 
ing, two or three weeks before, to firms all over the State so that 
it is competitive, blanks for the articles that we need for the en- 
suing quarter. 

Q. Are the provisions inspected by any particular person or 
persons of your institution to see whether they are standard and 
conform to the stipulations under which the} 7 were obtained, both 
as to quality and to quantity and price? 

A. By this supply committee that consists of three trustees, the 
chairman and the two trustees and the steward. 

Q. Suppose some of the supplies come in when the committee 
is not there? 

A. The steward sees as to the quality of the supplies at all times. 



Q. What are the requirements of admission under the existing law 
for a patient in your institution? Do you live up to the present 
law relative to the requirements of admission? 

A. You mean admission of patients? 

Q. Yes, sir. 

A. Yes, sir; that is either by certificate or court commitment. 

Q. What is the source of your water supply for drinking purposes? 

A. Driven wells ; two driven wells. 

Q. Have you any filtration plants? 

A. No, sir; it does not require it. It is very pure water and 
abundance in quantity for all purposes. 

Q. What provision have you made for the sewage of your institu- 
tion? 

A. We have large sewer mains that enter into the Oonewango 
creek about a half mile from the institution and they are flushed 
two or three times a week, oftener during the summer time than 
in the winter. 

Q. How are your buildings heated? 

A. By direct steam. 

Q. How are they ventilated? 

A. By fans; we have a fan for each wing, for men and women. 

Q. How frequently do your physicians visit the patients of the 
ward? 

A. I have four assistants, two for the men side and two for the 
women side and each make two visits a day and more frequently 
as the case may require; if we have any particular sickness in our 
institution they are in half a dozen times. 

Q. Are there any women managers of your institution? 

A. No, sir. 

Q. Would there be any advantage in having them? 

A. I would not think so. 

Q. How many visits have the board of managers of your insti- 
tution paid to it during the last year? 

A. Our board of managers are split up into different committees. 
We have a weekly visiting committee and a monthly visiting com- 
mittee and various committees, which are executive, on the farm 
and in the gardening and they attend to the employes and salaries; 
and there are some one or the other of those committees there all 
the time and we have a regular quarterly meeting, but then this 
meeting that I speak of, where the contracts are awarded, that 
precedes the quarterly meeting. So they are there almost con- 
stantly. 

Q. You have women nurses at your institution? 

A. Yes, sir; for the women. 



89 

Q. What proportion? 

A. About one to ten. 

Q. And the male nurses? 

A. About the same. We endeavor to keep it up to that point; 
on the men's side it is a little more difficult. 

Q. Do you think the manner of obtaining your supplies is the 
best possible manner of getting them? 

A. It seems so to me; I don't know any different way or any 
better way. We have samples of all we buy and they are inspected 
at the time. 

Q. How are your buildings lighted? 

A. By gas. 

Q. What rules have you in reference to the attendants being on 
duty? 

A. The attendants have a half a day each week, from 1.30 to 9.30, 
and every third Sunday from 10 to 9.30, and allowed an hour each 
day, if convenient, an hour or even two hours. 

Q. How many patients have you in the institution at the present 
time? 

A. Ten hundred and thirty. 

Q. How many are public and how many are private? 

A. All with the exception of seventy-five or eighty. 

Q. What is the capacity of your institution? 

A. About seven hundred. 

Q. And you now have one thousand? 

A. Ten hundred and thirty. 

Q. Do you think it would be better to enlarge your hospital or 
have an additional hospital built somewhere else? 

A. It seems to me it would be advantageous to add additional 
buildings. They could be taken care of if they were near enough to 
the main plant and under the present management it would be 
more economical to do so. 

Q. What are your rates per week for the respective classes, public 
and private patients? 

A. The rate for the public patients is fixed by law at $3.75 and 
$2.00 is the full limit to the 'State; and private patients we charge 
from $3 to $10, according to the amount of care and attention neces- 
sary. We have only two $10 patients in the hospital at the present 
time and that is owing to the fact that they require day and night 
attention; we could not do it for less. The average of the pay 
patients is $3.50, which you will observe is less than the public 
patients. 

Q. What restraint would you place on communications by letter 
from the patients to their relatives or friends? 



90 

A. None whatever, only where there is a special request made. 
You no doubt are aware that some of the insane indulge in vulgarity 
and all kinds of abuse to people who have nothing in common with 
them; so that the friends sometimes request that they should not 
be sent out. But all letters to attorneys and judges we are com- 
pelled to send them by law. 

Q. How often has the Board of Charities visited your institution 
during the last year? 

A. The Committee on Lunacy, by its secretary, I think twice last 
year; and the Board of Charities, by its secretary and maybe one 
or two members of the board, usually visit once a year. 

Q. That is, the secretary of the Board of Charities? 

A. Yes, sir. 

Q. Any other members of the Board of Charities visited your insti- 
tution? 

A. Yes, sir; he is usually accompanied by one or two members. 

Q. Do you know of any inmates of your institution with reference 
to whom you or your medical faculty entertain any doubts as to 
actual insanity? 

A. No, sir. 

Q. Have you any suggestions or recommendations to make with 
regard to the laws governing the admission of inmates at the present 
time? 

A. No, sir; I have nothing to suggest. I think the law is very 
good as it stands. 

Q. Have you noticed any abuses which have occurred under the 
present system of admission? 

A. No, sir. 

Q. Is the line of demarcation tightly drawn between the male and 
female inmates, as to social life? 

A. Always; we are very particular about that. 

Q. Is the line also drawn between the cases of acute insane and 
those of other types of insanity? 

A. Well, we endeavor notwithstanding the present circumstances, 
being very much overcrow r ded as I have stated, to classify as well 
as we can and to keep the violent and excited class separate and 
apart from the other sex. 

Q. From the milder classes? 

A. Y r es, sir. 

Q. What formula is adopted to obtain the discharge of a patient? 

A. Well, the law allows the superintendents to discharge any 
restored patient without consultation but I am in the habit of con- 
sulting with those who send them there, the county authorities or 
township authorities, and of course in the case of private patients 
they come without any consultation. 



91 

Q. And how is it with reference to the patients who are committed 
by the courts? 

A. 1 always require an order of court to discharge them under 
all circumstances. 

Q. Where committed by the directors of the poor you require 
what from the directors of the poor? 

A. To send me an order. Most of the discharges are made on 
trial. The lunacy law allows a trial of thirty days to see whether 
the patient would get along and if they get along in that time and 
do not return they are discharged. 

Q. What provision have you made in the case of the outbreak 
of any contagious or infectious disease in your institution? 

A. We have no special provision for anything of that kind, al- 
though in 1890 we had what promised to be a rather serious epi- 
demic of diphtheria. We had all together one hundred cases, or 
over, and then selected the upper stories of the rear ends of the 
building and isolated it as completely as possible and I am very 
glad to state that we did not lose a single case. Of course it would 
be preferable to have an outside building but we have no outside 
building. 

Q. What provision have you made in the case of an outbreak of 
fire? 

A. We have no fire escapes; our stairways are all slate and in 
common walls so there would be no possible connection with any 
flames and besides that we have hose in each ward so that if a fire 
would take place there it could be controlled by that means and 
we also have a fire apparatus and hose outside and they could als« 
be used. 

Q. What is your system of religious observance? 

A. One chapel service in the afternoon about 4 o'clock and about 
three services during the week when we have no other entertain- 
ments. We have two dances a week and usually one stereoscoptical 
entertainment, and other amusements. We have regular chapel 
exercises and have a room for that purpose and a hall for entertain 
ments; we never combine the two. 

Q. What is the formula by which you transfer cases from your 
institution to that of any particular county and what are the re- 
quirements and whose assent is necessary for such transfer? 

A. In many cases the county authorities come to the institution 
and inspect their wards and then they confer with the Committee 
on Lunacy and in company with those we sejd them, unless we have 
an order of transfer. It is always done that way, by order of 
transfer. 

Q. Do you believe that so far as it is possible, the application 



92 

of civil service principles would apply to your institution; would it 
be beneficial, would it be better by means of that system or under 
your present system? 

A. I don't see how it could be an advantage and chiefly for the 
reason that we cannot offer enough inducement to the attendants; 
the wages are not large enough. Our men attendants we take in at 
|16 and the women at $14 and the men attendants are gradually 
worked up to $26, according to the length of service, and the women 
attendants up to $24 a month. 

Q. Where do your employes chiefly come from? 

A. From the rural district. 

Q. From the farms? 

A. Yes, sir; chiefly. 

Q. Both male and female? 

A. Yes, sir. 

Q. Can you offer any suggestion as a means of preventing in- 
sanity? 

A. That is an all embrqacing subject, but I would like to state 
right here, that many years ago, (we are just in existence twenty- 
two years,) but a number of years ago our trustees thought it would 
be a good plan to have a superintendent of the institution at stated 
times, for instance once or twice a month, for those people who were 
threatened with nervous diseases and insanity to come there for con- 
sultation free and for the hospital to supply the medicine. If they 
could do that it would ultimately keep out that kind of cases, if 
kept up, and that has worked splendidly and I have frequently 
spoken to friends of patients and charged them what they must do 
and given them general directions to guard themselves and I found 
it quite beneficial. 

Q. Are your superintendents, stewards and matrons appointed 
by the board of directors? 

A. Yes, sir. 

Q. Who has authority to hire and discharge employes? 

A. I have, sir. 

Q. Do you think it would be an advantage for the superintendents 
of the different State institutions to have a meeting four to six times 
a year? 

A. I think it would be an advantage. 

Q. By what manner are the inmates transferred from the State 
institution to the county? 

A. That is done in the same way that I stated, by transfer, order 
of transfer from the Committee of Lunacy. 

Q. The law in the transfer of female patients is strictly ad- 
hered to? 



93 

A. Yes, sir; in all cases. It sometimes happens that that is not 
done but it is referred at once to the Committee on Lunacy. 

Q. (By Mr. Bliss.) You stated, in your judgment, that the en- 
largement of your institution would be more beneficial than the 
building of a new institution because it would be more economical. 
Do you look at it simply from the point of view of economy? 

A. Not altogether; I think we could add to the number of pa- 
tients, that each institution could be added to, but ultimately there 
will have to be another institution. 

Q. What, in your judgment, is the remedy where the capacity 
of an insane asylum is insufficient, looking at it from a point of 
view in the patient's interest and not with reference to the cost 
to the State? 

A. The number of patients at Norristown seems to act very well. 
They have about double the number we have; they have about two 
thousand. 

Q. Then, in your judgment, two thousand patients is not too many 
to be placed in one hospital? 
A. I think not. 

Q. I would like you to give us your judgment about the operation 
of the county law, passed in 1895, for the care of the insane by coun- 
ties; is it working well? 

A. I really have no knowledge as to its practical working but 
my own opinion is this, that I think it is a retrograde step as far 
as the smaller counties are concerned. I think it could be used 
advantageously for larger centres, like Pittsburg, Allegheny, Phila- 
delphia and like Retreat in the central part of this State, and my 
reasons are these: I don't believe they can get the proper super- 
vision in the smaller counties. I think there should be a resident 
doctor and attendant both day and night to look after the inmates 
because these insane people, even if pronounced incurable, are 
sick people and should be made as comfortable as possible. 

Q. What is the formula by which you transfer patients from your 
institution to that of any particular county? 

A. There has not been any transfers made for a number of years. 
Q. What is the judgment about the policy and wisdom of that 
system ? 

A. It seems to me it would be better not to take all classes in 
transferring patients, like the one at Wernersville, which is con- 
ducted economically, because it takes away a large number of useful 
men patients who could be used in the state hospital and in that 
way keep down the expenses. 

Q. How large a proportion of your inmates can be worked at 
indoor or outdoor employment, to the advantage of the institu- 
tion? 



94 

A. I judge about half the number we have out sometimes. 

Q. Do you have any difficulty in getting work out of the patients? 

A. That is variable; of course they do better at times. They are 
not like sane people. They are not driven. It is a matter for their 
own benefit and we encourage it under all circumstances. 

Q. What is your judgment as to the wisdom of the separate care 
of the criminal insane? 

A. I think that should be done. There should be special provision 
made for the criminal insane. 

Q. Would it require more than one hospital? 

A. No 3 sir. 

Q. What capacity should such a hospital have? 

A. I don't recall what number there are. We have comparatively 
few at Warren. 

Q. i By Mr. Sproul.) On this point of interchange of ideas, do your 
attendants belong to any organization composed of persons inter- 
ested in this character of work? 

A. No, sir. 

Q. Then the attendants and those in charge have no opportunity 
to confer on the subject of similar topics in the same class of work? 

A. No, sir; without it is the drifting ones, what we sometimes call 
the hospital tramp. 

■ Q. Have you discharged any patients during your administration 
as cured? 

A. Well, in my last annual report there were forty-two cases 
discharged and fifty-eight improved, making one hundred for the 
year. Of course they go back several years. I find that insanity 
sometimes goes over a period of years. 

Q. Then the remedial acts of the institution is kept constantly in 
mind? 

A. Yes. sir: it is a curative institution. 

Q. i By Mr. Hall.) Is the State appropriation large enough to 
accommodate the indigent insane from the State and county to- 
gether? 

A. From the fact that commodities of all sorts have risen so 
much in prices in the last two years, twenty per cent, according 
to Dunn. I should say not. On that account an extra provision 
should be made and that pro vision should not be less than $4 instead 
of 83.75. 

Q. Is there any difference between the treatment of private and 
public patients in your asylum? 

A. Xone whatever. 

Q. You don't charge as much for private as public patients? 

A. That was simply due to the fact that the rate was fixed low 



95 

so that persons in moderate circumstances could avail themselves 
of paying for their friends if they wanted to bring such patients 
there and thus relieve the State. 

Q. How large a proportion of your patients are pay patients? 

A. Seventy-five or eighty. 

Q. About one-tenth? 

A. Yes, sir; not a tenth. 

Q. It is possible for a person to be committed to an insane asylum 
without an inquiry by a magistrate? 

A. No, only by voluntary commitment. Any one can place them- 
selves in an institution for a month by presenting a certain paper 
in the presence of a witness, but that must be renewed at the end of 
that time. 

Q. Well, this law says that no person shall be received as a pa- 
tient for treatment or for detention in any house or place where 
more than one insane person is detained, or into any house or place 
where one or more insane persons are detained for compensation 
without a certificate signed by at least two physicians resident in 
this Commonwealth, who have been actually in the practice for 
at least five years, both of whom shall certify that they have 
examined separately the person alleged to be insane, and that this 
shall be duly sworn to or affirmed before a judge or magistrate of 
this Commonwealth and of the county where such person has been 
examined, who shall certify to the genuineness of the signatures 
and to the standing and good repute of the signers? 

A. That relates entirely to the standing of the physician, that they 
are of reputable character and have been in the practice of medicine 
for a period of five years before they can sign such a certificate. 

Q. And the persons who apply for admission of the patient; their 
signatures have to be certified to before a magistrate? 

A. Yes, sir. 

Q. Have you ever known any one in your experience committed 
to an asylum who was not insane? 

A. I have not. 

Q. I gather from your testimony that there is no restriction placed 
on correspondence in your institution? 

A. None whatever, sir. 

Q. (By Mr. McClain.) In your opinion, could a better system of 
management be provided than the one now in operation in Penn- 
sylvania? 

A. I think the system is a very good one. I have been connected 
as a physician with the State Hospital at Warren since 1880, since 
its inception, and for the last two years its Superintendent, and 
their control has always been very satisfactory, as far as T can 
observe. 



96 

Q. How often does the State Board of Charities visit your institu- 
tion? 

A. The State Board once or twice a year, and the Committee on 
Lunacy two and three times a year. You observe we are somewhat 
distant from the central office but we are in constant touch with 
them. 

Q. When they do visit your institution what do they inspect? 

A. They always go through the wards and give the patients an 
opportunity to enter any complaints; they also look into the books 
and make such other examination as they deem advisable. 

Q. Complaints are made to them by the patients? 

A. Certainly, and they always listen to them patiently. 

Q. Are you familiar with the system employed in the state of New 
York concerning similar institutions? 

A. No, sir; I have no experience in connection with their insti- 
tutions. 

Q. You would not know whether that is a proper method and a 
better method than we have? 

A. I know nothing about it; it would have to be tested. But my 
idea is this, that the local boards play a very important part in all 
our State institutions; they are men appointed by the Governor 
and are representative men in their communities and they represent 
their constituents in the different counties, like in our section, 
Mercer, Crawford or Erie county, and when these gentlemen come 
they always come with a lot of inquiries, so that they are in direct 
touch with the patients and it seems to be a very satisfactory plan 
and the friends have implicit confidence in those people. Then in 
the manner of furnishing supplies, etc., T don't see how any board 
can be more careful than the board at Warren. They are very par- 
ticular in sending out their bids and giving every one an opportunity 
to compete. 

Q. Would it not be expedient in the management of the different 
State institutions for some uniform system to be adopted for ob- 
taining supplies and some general concert of action to be adopted 
which would simplify the management of the several institutions 
and make them uniform? 

A. I believe there is some difference in the management of the 
different hospitals and it might be. perhaps, of some advantage to 
have all institutions in the State run on a uniform plan. Naturally 
we are apt to feel that our own is a little better than another, but 
the results in all I think are good. I know of no fault or complaints 
being made. The only thing I would suggest which I think would 
be an improvement in our present condition would be some means 
adopted whereby we are enabled to get better service in the way of 



97 

attendants; that seems to be the crying need. We are unable to 
pay sufficient to get the class of men we should have to act as attend- 
ants in connection with these unfortunate people and that is one 
of the important things to have around them because of their ail- 
ments and through sickness. It is a constant source of annoyance 
to have changes so frequently among the attendants. 

Q. Have you any suggestions or recommendations to make with 
regard to our present laws that would be a benefit to the care anr» 
maintenance of the insane? 

A. No, sir; I have not, not further than what I have stated. 

Q. What is the weekly cost per capita? 

A. Three dollars and seventy-three cents this present year and 
|3.43 last year. The difference is due to the buildings getting a little 
old and more repairs made in the one year than the other. I have 
been very much handicapped with reference to that for the reason 
that two years ago we found that our plumbing was defective and 
we asked for an appropriation but did not get it and that amount 
come out of the maintenance. 

Q. (Mr. Sproul.) That increases the cost of living? 

A. Yes, sir; of course. 

Q. Suppose that there was a central board in control of all these 
institutions, couldn't it make purchases and furnish supplies by 
means of purchasing by contract which would result in a considera 
ble saving of expense to the State? 

A. Of course I don't know. I have always thought that in dif- 
ferent communities there are special advantages for getting certain 
commodities and of course until such a system should be tried I 
could not state as to that. 

Q. (By Mr. Heidelbaugh.) In regard to supplies you say you do 
not advertise for competition but send blanks around? 

A. When this system was started we advertised but now these 
people are generally known and they communicate one to the other 

Q. How often do you send out these circulars or blanks? 

A. Every three months. 

Q. Suppose a person in business would make a bid that did not 
get one of the circulars would it be received? 

A. Certainly. 

Q. They are not sent to a favored few? 

A. No, sir. 

Q. There is no danger of that becoming too close? 

A. No, sir; it is very general, sir. 

Q. (By Mr. Anderson.) Is there a class properlv classi#e$ tha+ 
js known as the crimjnally insane? 

A, Yes, sir, 



Q. (By Mr. Hall.) How often does the secretary of the State Board 
of Charities visit your institution? 

A. Usually about two or three times a year. 

Q. You say one or two members visit once each year. 

A. Of the State Board of Charities? 

Q. Yes, sir. 

A. Once a year with two members. 

Q. The Secretary? 

A. Yes, sir. 

Q. Is that the only visit? 

A. Yes, sir. 

Q. The law says that they shall visit at least twice every year? 

A. Yes, sir. 

Q. Section 21 says: "Every house and place in which the insane 
are confined, shall, without previous notice, be visited by one or 
more members of the committee, or their secretary, twice at least 
in every year?" 

A. That is the secretary of the Committee on Lunacy, not the 
secretary of the Board of Charities. The secretary of the Board of 
Lunacy fills that requirement; he visits two or three times a year. 

Q. And members of the committee? 

A. No, he represents the Committee on Lunacy. 

Q. The Secretary of the Board of Charities, that is, Dr. Biddle, 
he visits your institution how often? 

A. Once a year on an average and one or two members of the 
Board of Charities. 

Q. The secretary of the Committee on Lunacy, how often does he 
visit your institution? 

A. Two or three times a year. 

Q. Do any of the members of the committee come? 

A. Occasionally. 

Q. The most of that work, however, is done by the Secretary? 

A. Yes, sir. 

Q. And not by the committee? 

A. No, sir; by the secretary. '"" ' 



1 



Mr. Snydter, Chairman. The next in order is the State Hospital 
for the Insane, southeastern district, located at Norristown, Dr. D. 
D. Richardson, chief physician. Dr. Richardson not being present 
at this time I take great pleasure in calling upon Dr. West, super- 
intendent of the Norristown Hospital for the Insane, 

Pr, J t L s West called an4 testified, a# f qllowg ; 



99 

My title is not superintendent. 
Examination conducted by Mr. Snyder, chairman. 

Q. How are your supplies obtained? 

A. By bids; there are no supplies obtained except obtained in 
that way. 

Q. Do you advertise them? 

A. We advertise annually and under the advertisement we specify 
that the bids will be received quarterly. We get bids in every 
quarter and the supplies as we want them. 

Q. Have you someone who inspects the supplies to ascertain 
whether they conform to the bids under which they were obtained, 
both as to quality and quantity? 

A. The bids that are made are based on the standards we have 
there. We have a storekeeper who examines the goods when they 
come in there; and if he is not satisfied with the quality, the assistanl 
steward and myself help him; and when we are not capable of judg 
ing of the quality we call in an outside merchant to help him and 
give our opinion. 

Q. What is the average proportion numerically of your attendants 
to the number of your inmates? 

A. About eight to one, in the neighborhood of eight. 

Q. What are the requirements of admission under the existing 
law for a patient in your institution? 

A. The same as has been mentioned by other superintendents. 

Q. What is the source of your water supply for drinking pur 
poses? 

A. We have an ample supply furnished from artesian wells and 
a reservoir. 

Q. Is it pure water? 

A. Yes, sir. 

Q. Is it filtered? 

A. ]S T o, sir; we have it so constructed that in case it is necessary 
we can empty one side and clean it out. 

Q. How are your buildings heated? 

A. By a steam central plant. 

Q. Have you ventilation? 

A. Modern methods of ventilation by heating flues and stacks 
for drawing out foul air. 

Q. Who employs the attendants? 

A. The doctors on either side: Dr, Richardson on the male side 
and Dr. Wolfe on the female side, 

Q. Who discharges them? 

Q. They employ them and discharge tljem, 

Q. Do you think that a system of supplies from some centrfD 
§ource wqu14 fte of adyantap gy^ tbe present system? 



100 

A. 1 don't think it would be any advantage in our case. We have 
a large institution and it is located near central territory for a good 
supply of provisions. 

Q. How are your buildings lighted? 

A. By electric light. 

Q. Has ample protection been made for proper insulating and 
protection from fires? 

A. We have used all precautions and the best materials in the 
construction of our plant to make it as safe as possible. 

Q. How many patients have you at the present time in your insti- 
tution? 

A. About 2,150. 

Q. What is the capacity of your institution? 

A. About 1,500. 

Q. Do you think it would be an advantage to enlarge the present 
institution or erect additional asylums at other points, both as to 
the comfort of the patient and also as to the expense? 

A. It would cost less to maintain them where there are a larger 
number together and give additional buildings for better classifi- 
cation. 

Q. How often do the Committee on Lunacy and the Board of 
Public Charities visit your institution? 

A. I can't tell you that but not very often. The doctors can tell 
that better than I can. 

Q. Have you any suggestions or recommendations to make with 
regard to the treatment of the indigent insane, do you think the 
present laws are sufficient? 

A. I think so, as far as I know, I think they are sufficient to protect 
the State. 

Q. What provision has been made in case of the outbreak of any 
contagious or infectious disease? 

A. We have no regular hospital; we have a small building in the 
grove that we fitted up when the small-pox epidemic broke out but 
we had no occasion to use it. We have several small buildings on 
the grounds that can be used. 

Q. Have you any contagious diseases there now? 

A. No, sir; I think not. 

Q. What is your system of religious observance there? 

A. Every Sunday afternoon and Wednesday evenings we have ser- 
vices in the chapel. 

Mr. Snyder. Has any member of the committee any questions 
to ask? 

Q. (By Mr. Sproul.) What did it cost to maintain the insane, 
per capita^ at Norrfstown last year? 



101 

A. Three dollars and thirty-eight cents. 

Q. That would appear to prove an advantage to the State, where 
there are so many together and it must be from having a greater 
number together that it was as low as that? 

A. Yes, sir; that is higher than the last year. That is due to 
repairs and higher prices paid for provisions. 

Q. (By Mr. Snyder.) Have you any suggestions or recommenda- 
tions that you can offer that would be of advantage to our present 
laws or the management of the insane hospitals of the State? 

A. I don't feel prepared to offer anything at the present time. 

Mr. Snyder. Dr. Richardson is now present and I call upon him. 

Dr. David D. Richardson called and testified as follows : 
Examination conducted! by Mr. Snyder, chairman. 

Q. Is there sufficient attention paid to the ventilation of the 
living and sleeping apartments in your hospital? 

A. Yes, sir; with the present system I think there is. 

Q. Are there any women managers of your institution? 

A. No, sir. 

Q. Do you think it would be any advantage to have any board of 
directors composed of women? 

A. That is an unfair question to ask because I am a woman's man. 
A good woman might do a great deal of good. She would have to 
be selected with a great deal of care. 

Q. How many visits has the Board of Charities made to your 
institution in the last year? 

A. They come up pretty often; Dr. Wetherill comes up frequently. 
We have sent for him and I guess there is not a month we don't see 
him; and Mr. Biddle comes in a number of times and goes around 
through the wards. 

Q. Any other members with him? 

A. Sometimes; and sometimes he is alone. 

Q. What are your rules governing absentees among the attend- 
ants? 

A. Do you mean the time they are allowed to be away? 

Q. Yes, sir. 

A. They are allowed to be away every other Sunday and part 
of a day and afternoon and every other night they are out about the 
hospital grounds from 7 o'clock until 10 when it is not their night 
on duty. 

Q. What is your regulation in reference to inmates writing let- 
ters to their friends or relatives? 

A. It is strictly in accord with the law; we examine the letters 
unless we know the patient thoroughly, yet some of my patients I 
would trust as well as myself. I don't examiue them if a letter is 



102 

address a to a lawyer or judge or a member of the Lunacy Commit- 
tee or a member of the Board of Charities; we let them go and dare 
not stop them. 

Q. Do you know of any inmates of your institution with reference 
to whom you or your medical faculty entertain any doubts as to 
actual insanity? 

A. No, sir. 

Q. Have you any suggestions or recommendations to make with 
regard to the laws governing the admission of inmates? 

A. No, sir; the law is a good law. 

Q. Have you noted any abuses which have occurred under the 
existing system of admission? 

A. No, sir. 

Q. Is the line of demarcation tightly drawn between the male and 
female inmates, as to social life? 

A. Yes, sir; very. 

Q. What formula is adopted to obtain the discharge of a patient? 

A. If a patient is restored the doctor in charge may discharge. 
If he is not restored his case is referred to the Lunacy Committee 
and he gets their consent; and if a criminal or convict he must 
be discharged through the Lunacy Committee, through court, if it 
is a case committed on petition as most are from Philadelphia. If 
committed by court we are allowed to discharge those if we think 
they are well. 

Q. Your provision for an outbreak of a contagious or infectious 
disease, is that ample? 

A. We have no provision. The trustees had a building arranged 
in case of an outbreak of small-pox but we had no occasion to use 
it. However, we had two cases of mild varioloid and they were sent 
by our medical board of health to the board of health of Norristown. 
If they would not have been provided with attendants, just as good 
as in the hospital, they would have been treated at the hospital 
by provising tents or something of that kind. 

Q. What are the rules regulating the transfer of patients from 
your institution to that of any particular county? 

A. You mean if the patient is a citizen of Delaware how he 
would get to us? 

Q. No, sir; to transfer a patient from your institution to one of 
the counties? 

A. We would report that to the Committee on Lunacy but if a 
trustee would bring a patient there we could not prevent his going 
with him. The trustees pay the board and expenses and the per- 
sons who pay the board and expenses have a right to withdraw 
their patients. 






103 

Q. Suppose the Chester county poor directors would want to 
withdraw a patient, in that case how would it be done? 

A. That is all done in the board; the list is sent to the Committee 
on Lunacy and they act upon it. 

Q. They write out a transfer permit and make a request for 
certain patients, or all patients? 

A. Yes, sir; we have a cople of convicts from Chester county that 
we still hold. They sent one to us after they erected their hospital. 
We hold those by their permission; they don't want them. 

Q. How many have been transferred from the Norristown hos 
pital to the Chester hospital? 

A. Somewhere about sixty; I couldn't tell you without looking 
at the record. * 

Q. Do you believe that a system of civil service principles for the 
employment of attendants would be an advantage, or is the present 
system a good one? 

A. I think the present system is a good one. We take men on 
trial and if they are not fit we so state it to them and they go 
away. 

Q. The superintendent, steward and matron are appointed by 
the board of directors? 
A. Yes, sir. 

Q. How often do the directors visit your institution? 
A. They have a regular meeting every month and a regular meet- 
ing between the regular meeting of an executive committee of the 
directors, and some of the committee is there every day. 

Q. And a portion of the executive committee is there every week? 
A. I can't say that; some of them may live quite a distance away 
but they are there regularly twice in a month and come sometimes 
in between those times. There is no regularity about that. 

Mr. Snyder, Chairman. Has any member of the committee any 
questions to ask? 

Q. (By Mr. Sproul.) Do I understand you to say that if a director 
of the poor would come there and desire a patient he has a right to 
withdraw his patient? 

A. Suppose a man has a patient there and he is anxious to have 
that patient to go home, and if he is not a convict or criminal I 
could send him on what we call a parole of a month and require a 
report from him and if it was reported at the end of two months 
that it was for the advantage of the patient to be discharged he 
is discharged!, but this discharge must go through the Lunacy Com 
mittee. 

Q. That is, the poor directors cannot come there and arbitrarily 
withdraw a patient? 



104 

A. No, sir; I have never known a case where there was an ob- 
jection, where we allowed them to go on trial. 

Q. (By Mr. McClain.) Is insanity on the increase? 

A. I think it is. 

Q. What cause do you assign for that increase? 

A. It is hard to tell that ; the cause that would affect one man would 
not affect another. That man who died a few days ago was in the 
habit of drinking a quart of whiskey every night and then there 
was a man who drank a quart and did not die. 

Q. You know of no particular cause? 

A. No, sir; hard times, intemperance and other excessive diseases 
in patients and diseases transmitted through hereditary taints to 
patients, are some of the very common causes of insanity. 

Q. So is intemperance a cause of imbecility? 

A. Yes, sir. 

Q. They are not new causes? 

A. No, sir; I don't know that there are any new causes. 

Q. (By Mr. Sproul.) Don't you think that the increase in the num- 
ber of people living in the city is undoubtedly responsible for it on 
account of the strain of city life? 

A. Yes, sir; I think so. We have more coming from the Philadel- 
phia district and some others of that character due to that cause. 

Q. (By Mr. McClain.) Do not the statistics prove that insanity 
is increasing more rapidly in proportion to the increase of the pop- 
ulation? 

A. I don't dispute that. Everything is getting higher and it costs 
more to live and life is becoming a more strenuous effort. 

Q. (By Mr. Bliss.) Does the State Board of Charities or the Com- 
mittee on Lunacy exercise any control or authority over the Nor- 
ristown institution? 

A. No, sir; not any more than elsewhere. 

Q. As a matter of fact they do not assume any? 

A. I would not say that; we can't discharge a man without their 
consent and can't discharge a criminal without it going through 
court. We have no authority over people who are restored men- 
tally. 

Q. As I understand the local board has entire control? 

A. The local board does not conflict with Committee on Lunacy 
nor the committee of the Board of Charities. The local Board man- 
ages everything. 

Q. In your judgment wouldn't it be better to have a single central 
board of charities as a board of control, such as exists in some other 
states? 

A. I don't know as it would. The institutions that I know get 



105 

along so well that I can't conceive now they could get along any 
better. 

Q. Do you think it would be any better in having uniformity for 
their government and thus placing the management in the nature of 
some well defined system, instead of allowing each institution to 
make its own rules and regulations? 

A. I can't say about that, but I think the plan we have in opera- 
tion has worked so well that I have never studied any other. I 
think that our hospital is a peculiar hospital, it is peculiarly man- 
aged; there are two departments, one for men and one for women 
and both managed by one local board. 

Q. You think the uniformity plan would be all right provided the 
Norristown system was adopted? 

A. No, sir; I don't mean to say that. 

Q. It seems that each one has the idea that its system is the 
best? 

A. No, sir; I don't think so. I know hospitals that I don't think 
their system is half as good. We have just two committees at our 
hospital and are not encumbered with so many committees. The 
doctors have nothing to do with anything in connection with the 
running expenses of the institution as a part of their work; the 
only thing I know of the expense is the price of a postage stamp. 
Our work is professional and we have nothing to do with the man- 
agement; that is done by Mr. John West and his assistants. 

Q. If you could take advantage of other hospitals doing the same 
kind of work in the same state, would it not be beneficial to take 
advantage of the experience of other hospitals? 

A. I don't know except what I have stated here. 

Q. Don't you think it would be wiser to have all the insane 
asylums of the State under such central control so that the experi- 
ence of one may be taken advantage of in the other institutions? 

A. It is not intended that our physicians shall know anything 
about it. The trustees employ us and tell us that we are to take 
care of our patients. We have eleven teamsters in connection with 
our institution and I don't know who they are and I don't care. 
My instructions were given to me by the trustees, that I was to take 
care of the patients. 

Q. You have so many patients that it would be impossible to get 
to other hospitals? 

A. No, sir; I believe that a hospital can manage five thousand 
patients if there are a few more attendants and clerks. 

Q. Then your judgment is that it would be best to enlarge the 
present hospitals rather than to build additional hospitals? 

A. That is decidedly my judgment; I have always held that. 



106 

Q. Explain to us the basis of that judgment? 

A. In an economical view it would be the better plan and it 
would be better for the patients; and in that way we can afford to 
have better amusements, better diet, more extended grounds and 
hence patients be taken out more, more attendants and all the ad- 
vantages I look at, seems to me, would be in favor of extending 
the present hospitals. 

Q. Wouldn't you be required to have the same number of attend- 
ants per patient as you have now? 

A. One to ten. 

Q. There would be no saving in that? 

A. There would be more attendants, all told, and the means of 
diverting the patients would be greater, we have certain means of 
conducting our patients, one word in regard to that: The male 
attendants dance with the female patients and the female attend- 
ants dance with the male patients, so that the male and female 
patients do not dance together. 

Q. Who has supervision over these attendants while on duty? 

A. I have general supervision over them. 

Q. And you think if you had five thousand patients there and a 
requisite number of attendants and assistants you could manage it 
as well as you can one thousand? 

A. No general pretends to supervise all the army; first under me 
is the supervisor, under him is the captain and under him is the 
lieutenants, and if there is complaint and it can be settled before 
it comes to him it is settled and if not it comes to me. 

Q. Do you think that a general superintendent who has in his 
charge the care of the hopelessly insane is able to manage five 
thousand patients and at the same time take care of the lieuten- 
ants and captains? 

A. Yes, sir; he has medical men who are in contact with him every 
day and take three meals a day and sleep within call. 

Q. Isn't there great abuse committed, due to the fact that the 
authority is divided, and here and there some unworthy person will 
slip in and will not that increase as the number of patients in- 
crease? 

A. I believe that a doctor's head is about as good as a military 
man's head and why shouldn't he manage just as many patients. 
It is not expected of a superintendent that he should go and shake 
hands with every one and say something nice every day. 

Q. How many insane soldiers do you think a general could com- 
mand? 

A. They are not as hard to manage as some of the soldiers. 

Q. How many insane soldiers could an officer manage and compel 
to obey him? 



107 

A. It depends altogether on what you mean by management; a 
doctor does not force the patients, a nurse does that. 

Q. Carrying out that idea and taking an army of five thousand 
persons, having an officer, a number of lieutenants and captains, is 
it your opinion that an army could be taken care of as well as an 
army of one thousand persons? 

A. If a general knows his work and has proper men under him 
and has a proper system I don't see why he should not be able to 
do so. 

Q. Isn't it your judgment that an asylum containing two thou- 
sand, or five thousand, that the number of curable cases would not 
be as great as an asylum containing one thousand? 

A. I don't see how that could be, if you exclude such cases as 
are placed in Kirkbride's from the hospitals of the State. Ordi- 
narily at Norristown our trustees require us to admit every one 
who comes with proper papers and our idea is that we can do better 
than they can do outside and better than in the larger hospitals in 
the city where there are more of the hopeless class. What they 
need is good fresh air and good nourishing food. Of course, the 
doctor does not go over the whole field because if he did he would 
not need his assistants. It depends on how he trains them and what 
he requires of them. 

Q. Do you think there ought to be a separate hospital for the 
criminal insane? 

A. My opinion is not to be ; I think they ought to be treated. That 
class of people seldom ever get well. 

Q. How about the man who has been acquitted of some crime 
on the ground of insanity? 

A. I suppose you mean one who has committed a murder? 

Q. Where should he be confined? 

A. I mean this, I suggest this as a make-shift: I believe that if 
the State would consent to it, it would be to have some large hos- 
pital in the central part of the State for the convict insane; I believe 
that would be better, but in the emergency I think that wards 
ought to be put up for these people in connection with the peniten- 
tiary. We had a case in point at Norristown. A man by the 
name of Kew committed two murders and was committed to the 
penitentiary for life and some man in Philadelphia had him at 
Norristown. I say let him die there and not commit him with 
better people. I think something ought to be done right away. 

Q. Can you give the commission any idea as to how many men of 
this character there are in this State? 

A. Probably two hundred or two hundred and fifty; but the hos- 
pital could be built for three hundred and more if necessarv. 



10S 

Q. What is your judgment of the working of this county system? 

A. I don't know much about the working of it; but I believe the 
county plan is proper if properly conducted, but I don't believe it 
is if it has a doctor to drive around and say, how are you, and that 
is what it will grow into. 

v*. Wouldn't that work all right if it was under the charge and 
control of a central board? 

A. I don't see how a central board could supply the deficiency of 
La absent doctor or somebody to look after these people. This 
State was in a deplorable condition before the State Board on 
Lunacy began to put it into proper shape. Men were chained down 
with chain and bolt and chained in outbuildings and other such 
conduct we used to hear of before the inauguration of these commit- 
ees. If you have a good hospital and have some person of character 
did ability to look after the insane in these counties, where they 
are placed under their charge, it may be very well. 

Q. (By Mr. Snyder.) Is there any amendment to be made in our 
present law that, in your judgment, would be beneficial? 

A. I don't know except with reference to that law which allows 
a man to commit himself; the law allows him to commit himself for 
thirty days and does not provide for his expenses and in conse- 
quence oftentimes we cannot admit them because they have not 
the means to pay. I have had a number of cases where they come 
and state that they believed they were going insane and desired 
to be admitted. 

Q. (By Mr. Hall.) Have you visited any of the county asylums? 

A. I have been to the Chester county institution once. We have 
reports from there through the Committee on Lunacy and the 
Board of Charities. The secretary told me that the hospital was 
doing very well and there was nothing to complain of. 

Q. That is in such cases where they could have the same care and 
supervision as at the State hospitals? 

A. Yes, sir; that is the meaning of the act. 

Q. And you think the meaning and intention of the act is being 
carried out? 

A. I have no means of knowing that. I know that Dr. Baker is 
a good woman and good doctor, and I haven't the least doubt but that 
she is doing it all right. 

Q. What communications do you regard as privileged between pa- 
tients and persons outside? 

A. A letter addressed to a lawyer or Committee on Lunacy or 
Board of Public Charities or judge, district attorney, and letters 
which are not fit to go out, those letters have to be sent to the Com- 
mittee on Lunacy. 






109 

Q. You have no right to interfere with the letters addressed lo 
the persons you have mentioned? 

A. Xo, sir; we put the stamp on it and send it out. 

Q. Is that provided by law? 

A. Yes, sir. 

Q. I see here in the rules and regulations of the Committee on 
Lunacy, ordained by the Board of Public Charities, with consent 
of the Chief Justice of the Supreme Court and the Attorney General 
of the Commonwealth of Pennsylvania, that "Every letter written, 
not oftener than once a month, by any patient, in any house, or 
place, subject to the provisions of the lunacy law and addressed to 
any member of the Committee on Lunacy, or to their secretary, shall 
be forwarded forthwith, unopened and without inspection." 

"Every letter written by a patient in any such house, or place, and 
addressed to any person, other than the Committee on Lunacy, or 
their Secretary, shall be forthwith forwarded to the person to 
whom it is addressed, unless the superintendent, proprietor or man- 
ager of such house, or place shall, for sufficient reasons, prohibit the 
forwarding of such letter, in which case he shall, by endorsement to 
that effect, under his hand, on the letter give his reasons therefor; 
and he shall lay every such letter before the visiting member or mem- 
bers of the Committee on Lunacy or their secretary, as the case may 
be, on their next visit." 

A. Yes, sir; that is carried out. 

Q. Does that give you the power to keep any kind of letter from 
going out? 

A. If it is an improper letter. 

Q. It says: "Every letter written by a patient in any such house, 
or place, and addressed to any person, other than the Committee 
on Lunacy, or their secretary, shall be forthwith forwarded to the 
person to whom it is addressed, unless the superintendent, pro- 
prietor or manager of such house, or place, shall for sufficient reason, 
prohibit the forwarding of such letter." Could you, under that, 
prohibit the forwarding of a letter to a judge? 

A. No, sir; I would not attempt to do it. A letter addressed to a 
lawyer, by a patient, or to a judge or Committee on Lunacy or dis- 
trict attorney, would go. 

Q. Literally, that would give you the power to stop any communi 
cation? 

A. I don't take any advantage of that. 

Q. I suppose if there was an indecent or abusive letter addressed 
to a judge you would stop it? 

A. I would not open a letter addressed to any of the parties 
named and therefore would not see the contents of the letters to 



110 

those parties in order to see whether they are fit to go out or not 
because I don't know what it is unless I read it. I consider that 
it is not any of my business to know the contents of the letter ad- 
dressed to the county officials, the judge, the district attorney, the 
Committee on Lunacy. 

Q. Have you ever known of a person committed to an insane 
asylum on the certificate of two physicians as being insane, who was 
not insane? 

A. I know of persons who were committed to prison, thought to 
be insane, who were not insane; a man sent to the penitentiary for 
five years, properly certified to from Moyamensing, as being insane 
and not insane. There was no reason why the doctor should do that 
except he thought he was insane. 

Q. Is it not difficult sometimes to determine a man's insanity? 

A. Yes, sir; but sometimes a man overplays his part; that is the 
very thing that criminals are apt to do. 

Q. That is, the difficulties are that people wish to make it appear 
they were insane rather than that they are insane? 

A. Yes, sir. 

Mr. Hall. The reason I ask these questions is, because a number 
of letters have been addressed to me stating that a number of people 
were in the asylums who were not insane. 

Q. (By Mr. Marshall.) How many of the asylums of the State have 
you visited? 

A. I have never been to Dixmont; I have been to Danville and 
I assisted in organizing the Warren State Hospital. Dr. Guth, who 
was on the stand, went with me to Warren and we organized the 
institution. 



Dr. Mary Wolfe, of the Norristown State Hospital, called and testi 

fied as follows: 

Examination conducted by Mr. Snyder, chairman. 

Q. Have you any suggestions to offer to improve the quality of 
the food supply, or improve the purity of the water supply in your 
institution? 

A. No, sir; I think our food on the whole is very good and also 
pur water supply. 

Q. There are no women managers in your institution? 

A. No, sir. 

Q, Do you tWnk they would be an advantage? 



Ill 

A. J hardly know. I do know that in Massachusetts and some 
of the other states they have tried that system and it has been 
claimed to be a success. There is nothing- of that kind in Pennsyl- 
vania, and I would not know what to say. 

Q. How many nurses, according to the number of patients have 
you in your institution? 

A. We have about one to ten. 

Q. The restrictions, in reference to letters in your institution, 
is about as Dr. Richardson has stated? 

A. Yes, sir. 

Q. The same practice is observed in your department as in the 
male department? 

A. Yes, sir. 

Q. How many times has the Committee on Lunacy and the Board 
of Charities visited your department? 

A. Dr. Wetherill has been once to the hospital, about once in 
six months, two or three times a year. The secretary of the Board 
of Charities has been at the hospital, but I do not always see him 
when he comes, but I understand he comes more than once a year. 

Q. He does not always come to your department when he visits 
your institution? 

A. No, sir. 

Q. Have you any suggestions or recommendations to make with 
regard to the laws governing the admission of inmates? 

A. I have not. The only trouble I have had is with reference to 
the commitment papers because sometimes I cannot get as good a 
history of the patient as I would wish. On account of the form 
they cannot make it very long and necessarily it is very short and 
one cannot get it from the patient. 

Q. What form have you for the discharge of a patient? 

A. Just as Dr. Richardson has stated it. 

Q. It is the same in your department as in the male department? 

A. Yes, sir. 

Q. What is your judgment as to the enlarging of the Norristown 
asylum, with reference to putting up more buildings, or the estab- 
lishment of other asylums in other parts of the State? 

A. I don't know that my judgment would be a fair one, because 
I know very little of the other asylums, except as I have visited them; 
of course you cannot always get a true idea of them in that way. 
But as far as economy is concerned, I think it would be more econom- 
ical to have the hospital enlarged, but, on the other hand, the ques- 
tion comes in as to whether the patients come in contact with the 
physicians in a larger institution in the way they should. It is some- 
thing that | would not want to state one way or the other to you, 



112 

Q. Have you any suggestions to offer that would improve our 
present laws in reference to the care and commitment of the in- 
sane? 

A. Well, I sometimes think that maybe, medically, we do not 
do all that we might do for the patient. I think we do all we can 
under the existing circumstances but sometimes I think we do not 
do all that we could do in the way of treating the patients, the 
same as we would if outside in giving them all the advantages 
they would have in a general hospital. It is still an open question 
how much the bodily ailment of patients has to do with their mental 
condition. I know that our Norristown hospital is not equipped in 
every way to give them a cure in every case in that way. 

Q. How many patients have you in your department? 

A. Eleven hundred and twenty-one. 

Q. How many should there be? 

A. I believe we have air space for eight hundred and seventy-four. 
In addition to that we have to consider that we have attendants who 
have to live there also and there are one hundred and thirty-five 
of them. 

Q. Are you prepared in case of an outbreak of fire? 

A. Yes, sir; we have hose in each one of the sections and in addi- 
tion to that we have a system of fire buckets we use, and we have 
slate stairways which lead to the ground and have certain rules 
that the attendants are supposed to obey in taking patients out 
of the building. 

Q. What provision have you in case of the outbreak of any con- 
tagious or infectious disease? 

A. Well, we have such places that could be occupied very quickly 
in case it should occur. 

Q. (By Mr. Sproul.) With reference to your stating that it might 
be advantageous for the enlargement of the hospital, rather than 
to build others in other parts of the State, I suppose you mean that 
the funds available might be larger and better facilities might be 
provided in the larger hospital? 

A. Yes, sir; and in addition to that more modern medical care 
might be given. We have a hospital at Norristown containing 
about twenty-two hundred people and with that we have no modern 
operating room to take advantage of the advance in surgery. 

Q. You need better facilities then? 

A. Yes, sir. 

Q. Have you an ample number of attending physicians? 

A. That is for the trustees to decide. I have nothing to do with 
that. 

Q, In your judgment? 



113 

A. I think we ought to have more. 

Mr. Snyder. I have received a telegram from Dr. Hill, of the State 
Hospital for the Chronic Insane at Wernersville, stating that he 
is unable to be present with the commission on account of illness in 
the family. 



Mr. Snyder. The next in order is the State Institution for 
Feeble-Minded of Western Pennsylvania, located at Polk, Pa. J. M. 
Murdoch, M. D., superintendent. 

Dr. J. M. Murdoch called and testifies as follows: 

Examination conducted by Mr. Snyder, chairman. 

Q. What has been the result of the industrial training of your 
patients with regard to the raising of stock, farm labor and different 
kinds of work? 

A. I would say that the institution of which I am superintendent 
is a training school for feeble-minded children or institution for 
feeble-minded children. In it we have two classes of children; 
we call them all feeble. Those who are susceptible of improvement 
under training and those for whom little can be done but who require 
special custodial care and those who require no such care and 
many of them may be made useful in farming, stock raising, raising 
of small fruits and in various industrial ways we find that the feeble 
minded can be employed in industries and governed and by so 
doing they can reduce the cost of their maintenance and they are 
happier and less burdensome on others and less expensive to car<^ 
for by being profitably employed. 

Q. What is the average proportion numerically of your attendant* 
to the number of your inmates? 

A. About one to twenty-five. 

Q. What is the source of your water supply for drinking pur 
poses? 

A. We have some very excellent springs which are on an eleva 
tion of about two hundred feet above the buildings and they supply 
from three to four hundred gallons of water a day which is ample. 
This comes through the buildings by gravity. 

Q. What provision has been made for the sewage of your institu 

A. Our sewerage is to the creek, Sandy creek, which is polluted 
by sulphur by coal mines, so that the contamination of the stream 
is not of importance. 

8 



114 

Q. How many visits have the managers of your institution paid 
it it during the last year? 

A. We have a board of nine trustees who hold monthly meetings 
but between the meetings some of the trustees go through the in- 
stitution, and in case I wish to consult with them I am in constant 
telephone connection with them. 

Q. How are your buildings lighted? 

A. They are lighted by electric light and heated by steam, direct 
and indirect. 

Q. How many patients have you in your institution? 

A. Eight hundred and fifteen. 

Q. What is your capacity? 

A. Six hundred. 

Q. Are some of them private patients? 

A. Yes, the number of private patients is comparatively small. 

Q. What do you receive a week, per capita, for their care? 

A. We receive $3.50 a week. 

Q. Do you make any distinction, in rates, between the private 
patients and the indigent insane? 

A. We make no distinction between the private and the indigent 
patients and the charge is the same, $3.50. 

Q. The public patients, are they charged for their clothing? 

A. Yes, sir; or furnished by their relatives or the poor district 
from which they come and that is in addition to the $3.50. 

Q. How often has the Committee on Lunacy and the Board of 
Public Charities visited your institution during the last year? 

A. The Committee on Lunacy visit us. twice a year and last 
year members of the Board of Charity have been at our institution 
three times. About two weeks ago we were visited by Mr. Torrence, 
Mr. King and Mr. Boyle, three members. 

Q. How are your supplies obtained? 

A. By contract through bids. 

Q. How often? 

A. Quarterly. 

Q. Have you some one to inspect the quality in order to ascertain 
whether it conforms to the stipulations under which it is obtained? 

A. I do that myself and also the steward. I leave that to the 
steward, if there is anything questionable about the character of 
it, he refers it to me. 

Q. Are the patients happier and do they seem to improve more 
rapidly when thus employed at the different industrial works you 
have there? 

A. Undoubtedly so. 

Q. Whf(t compulsion do you use, if any, to obtain their services? 

A. No compulsion; we use moral persuasion. 



115 

Q. Does that always answer the question? 

A. We find that the feeble-minded are very easy to get along 
with, with little kindness and little flattery. They enjoy work 
and feel that it is a privilege to be allowed to do so. Give a boy 
charge of a team of horses and he takes great pride in it. 

Q. Are they governed by any strict rules? 

A. They are allowed a great deal of freedom and of course gov- 
erned by strict rules. 

Q. What is the formula for the admission of inmates in your 
institution? 

A. It is necessary, if the parents are living, for the father to 
make application, giving answers to a list of questions we have on 
a blank, in regard to the history of the case and the antecedent. 
This must be sworn to before a magistrate. The physician must 
swear that the child is of feeble mind and on account of his mind 
is unsuitable to obtain an education in the common schools of the 
State. 

Q. Have you one of those blanks with you? 

A. No, sir. 

Q. Will you kindly mail one to the secretary? 

A. Yes, sir; I might say further, in the case of admission, the law 
says that inmates may be admitted under the same system that 
governs the admission of patients into the State hospitals for the 
insane. In the case of adults we require a certificate of two phy- 
sicians, who are in good standing and have been in practice for five 
years and make an oath before a justice of the peace. 

Q. Who has the hiring and discharging of the attendants? 

A. I have. 

Q. How often do the board of directors meet in your institution? 

A. Monthly. 

Q. Are there a portion of them who come more than that? 

A, Yes, sir, the regular meeting is held on the second Tuesday 
of every month. 

Q. Have you any suggestions to offer as an amendment to our 
present laws concerning these institutions? 

A. Nothing, unless it would be in the way of providing additional 
accommodations. I have a recommendation in that direction. 

Q. Have you any record you wish to file? 

A. Yes, sir; I have a statement here (produced and handed to 
the secretary). 

Mr. Snyder. Has any member of the committee any question to 
ask? 

Q. (By Mr. Hall.) You stated the number to be what in your insti- 
tution? 



116 

A. Eight hundred and sixteen. 

Q. Which is more than the accommodation provides for? 

A. Yes, sir; quite a little more. 

Q. Is there any age limit for the admission of inmates to your 
institution? 

A. No, sir. 

Q. Is there a separate place in the institution for the treatment of 
the feeble-minded of different ages? 

A. Yes, sir; I would say, however, the ordinary children, in con- 
nection with the feeble-minded, does not signify the age. A feeble- 
minded person is always a child and it is common to speak of them 
as children. 

Q. You have none there in any ways dangerous? 

A. We have no insane. 

Q. Just quiet and tractive? 

A. Yes, sir; they must have been feeble-minded from infancy, 
only idiots and imbeciles. In the term feeble-minded is included 
idiots and imbeciles, it being a less harsh term for parents and rela- 
tives. 

Q. You would advise the enlargement of the institution? 

A. Yes, sir; I certainly would. I would advise the erection of 
buildings, one for the improvable and another as a custodial de- 
partment for the unimprovable. The building commission had ad- 
mirable plans drawn for the erection of an educational and custodial 
department but they were only able to erect the educational or 
training building and we are now taking care of these lower grade 
children in the training school and we should have a special depart- 
ment for them. 

Q. That has been in existence for how many years? 

A. Since the act passed ; it has been open about six years. 

Q. Where do the children come from? 

A. The first children were received from Elwyn, in the eastern 
part of the State, one hundred and fifty children. They were chil- 
dren who had been sent there from the western part of the State, 
and large numbers were received from the various county homes 
and there are a number who are brought direct from their own 
homes. 

Adjourned at 12.45 P. M., to meet at 2.30 P. M. 



117 



AFTERNOON SESSION. 



Met pursuant to adjournment. 

Mr. Snyder, Chairman. The next in order are the county institu- 
tions, the first on the list being the Adams County Almshouse, Get- 
tysburg. 

There being no response, the next on the list is the Allegheny 
City Home and Hospital for the Insane, at Allegheny, Pa. 

There being no response the next on the list is the Allegheny 
County Home at Woodville, S. W. Lea, superintendent. 

Dr. Strodes. Our superintendent, Dr. Lea, will not be present. 
He requested me to come and represent him. 

Dr. G. L. Strodes testifies as follows : 

Examination conducted by Mr. Snyder. 

Q. You are a physician in the Allegheny County Home, located at 
Woodville? 

A. Yes, sir. 

Q. How many patients have you? 

A. Three hundred and forty-nine. 

Q. They are all charity patients? 

A. Yes, sir. 

Q. Do you recollect about what the cost of maintenance is for 
those patients per week? 

A. Our last annual report shows $2.32. 

Q. What provision have you in case of fire? 

A. Well, our building is one of the modern fire proof buildings. 
We have also a' connection with the main pipes of the Char tiers 
Water Company and fire plugs throughout the building. 

Q. Have you any fire escapes? 

A. We have no fire escapes; our building is only two stories in 
heighth. 

Q. What provision has been made in case of the outbreak of 
any contagious or infectious disease? 

A. We have a number of temporary buildings at present outside 
to be used for that purpose but they are still building to out- 
building. 

Q. Have you had any infectious or contagious diseases there re- 
cently? 

A. No, sir. 

Q. What is the average proportion, numerically, of your attend- 
ants to the number of your inmates? 



118 

A. About one to ten. 

Q. You have patients there all the time? 

A. Yes, sir; there are two there all the time. 

Q. Has there been any inmates of any State institution transferred 
to your institution recently or any transferred from any county in- 
stitution to your institution? 

A. At the time our building was first occupied, on October 1, 
1900, there was quite a number transferred from Dixmont to our 
institution. 

Q. How often does the Board of Charities visit your institution? 

A. About two or three times a year and the local members of 
the Board of Charity are there quite frequently. 

Q. What is the formula for the admission of patients to your in- 
stitution, what do you require of the patients brought there? 

A. An examination by two physicians and on their certificate; 
it is done in accordance with the regulation for the admission of 
patients. 

Q. What do you require for the discharge of patients? 

A. It is the same for the discharge of patients and is reported to 
the board. 

Q. Do you not believe that so far as it is possible the application 
of correct civil services principles for the employment in the various 
hospitals would be beneficial? 

A. I don't see how it could be. 

Q. Have you any suggestions or recommendations to offer in 
reference to any amendments to our present laws that would be 
beneficial? 

A. The only thing I thought of in regard to the admission of a 
person to an institution like ours was, I think it would be well to 
amend the law so that a certificate of insanity, witlj the oath of the 
physicians, could be taken by a notary public as well as by a mag- 
istrate or justice of the peace. It is not so now. 

Q. (By Mr. Hall.) That would be largely a matter of convenience? 

A. Yes, sir; it is almost a necessity. Under the present law it 
cannot be done but it very frequently happens that cases are ad- 
mitted from the country districts and they must be provided for 
promptly and at or near all these institutions they have a notary 
public and he could do that there and thus at times save a great 
deal of inconvenience and bring about a more prompt action in the 
case. There does not seem to be any reason why it should not be so. 

Mr. Snyder. Has any member of the committee any questions 
to ask? 

Q. (By Mr. Hall.) What year was your institution opened? 

A. On October 1, 1900. 



119 

Q. It was built especially for the insane? 

A. Yes, sir. 

Q. In close proximity in its arrangement and equipment to an 
asylum? 

A. Yes, it is in close proximity to that. 

Q. It was intended for the insane exclusively? 

A. Yes, sir. 

Q. And was built looking to their care? 

A. Yes, sir. 

Q. Does it seem to answer the purpose? 

A. Yes, sir. 

Q. It is really just a smaller asylum for the insane? 

A. Yes, it was built with the idea of accommodating four hundred 
and with plans that it could be enlarged as it was needed. 

Q. You have physicians there all the time? 

A. Yes, sir; they live there and I live right in the building. 

Q. And of course there are attendants or nurses among them all 
the time? 

A. Yes, sir; we have male and female nurses and attendants. 

Q. Of course the sexes are separate? 

A. Entirely so. 



Mr. Snyder, Chairman. The next in order is the Blair. County 
Home for the Insane, Hollidaysburg, Pa. 

P. H. Brindenbaugh called and testifies as follows: 

Q. You are the 'Superintendent of the Blair County Home for the 
Insane, at Hollidaysburg? 

A. Yes, sir. 

Q. Is this institution built as an insane hospital and always used 
for that purpose? 

A. It was not built primarily for an insane institution; it was put 
up in 1892 and finished in 1893, and was built in accordance with 
modern plans. We commenced to keep insane inmates in it in 
1893 at the request of the State Board of Charities. 

Q. How many patients have you at this time? 

A. Ninety-eight. 

Q. What is the cost per capita for the maintenance of the pa- 
tients? 

A. I can answer that question in two ways; now if you want to 
know that cost to the county I can give it to you in that way. 



120 

Q. They are ail free patients ? 

A. They are all indigent patients but the net cosi to the county 
is a different thing to the cost per capita. 

Q. What does it cost you in the insane department? 

A. Last year it run about $2.16 per week. 

Q. That does not include the paupers in the other department? 

A. That is the general average of the institution. 

Q. You have not figured it just what the insane cost per capita? 

A. No, sir; the insane would not cost as much. In figuring out 
that we require more attention to the insane than the others, but 
we have a large farm and everything of that kind and now our per 
capita is less than it would be in the city where we would have to buy 
everything. 

Q. What provision has been made in case of an outbreak of any 
contagious or infectious disease? 

A. We haven't any separate building at the present time with 
the exception of a small farm house with four small rooms in it, 
which has been used for some years, but yesterday our board of 
directors adopted plans for a contagious disease hospital which 
has been the subject of considerable thought on the part of our 
people for the last year, and it is to cost from six to eight thousand 
dollars. 

Q. How many nurses have you in attendance to the number ol 
your patients? 

A. Well, we have two female attendants, one is a professional 
nurse for the female department and she is there all the time. There 
are two others who assist at meal time and other times when needed 
and we also have others there to fill the position of seamstresses 
and in the laundry. 

Q. Have you a physician there all the time? 

A. No, sir. 

Q. How near does the physician live to your asylum? 

A. About a mile and a quarter; we have a telephone to his house 
and office. 

Q. Where do you obtain your water supply? 

A. We obtain our water supply from the mountains. If you 
have ever crossed from Altoona, around the horse shoe bend, or 
near the tunnel is a large spring. 

Q. How about your sewage? 

A. I might also add with reference to our water supply, that our 
system of water supply is brought from two springs about three 
miles and a half away by gravity and we have two large storage 
reservoirs, more particularly for fire. We have an 8-inch sewer 
running into the Juniata river. 



121 

Q. What protection have you in case of tire; have you any fire 
escape? 

A. Yes, sir; I brought with me a photograph showing two rear 
views of the building and it shows the fire escapes. This is the 
front view (producing photograph). Those are good iron stairways 
(pointing) and perfectly safe. 

Q. (By Mr. Hall.) They are just two story buildings? 

A. Yes, sir. 

Q. (By Mr. Snyder.) Your food supply is furnished through your 
directors of the poor? 

A. Yes, sir; our base of supplies is right there. We have a large 
farm and do our own trucking and gardening and slaughter our own 
cattle. We also have a cold storage house and our base of food 
supply is excellent. 

Q. Your formula for the admission of patients to your institution 
is about the same as has been explained by your predecessor? 

A. Yes, sir; on the certificate of two physicians and order of the 
court. 

Q. How often does the Board of Public Charitiesi visit your institu- 
tion? 

A. The secretary of the Board of Charities, Mr. Biddle, makes one 
visit a year and the secretary of the Committee on Lunacy makes 
frequent visits. 

Q. Is that Dr. Wetherill? 

A. Yes, sir; his visits are lengthy. 

Q. What is your method for the discharge of patients? 

A. We have encouraged the system of parole very much in our 
institution. That is, we encourage it among the patients and their 
friends; I encourage their friends to take them out and try them 
when I think they are fit, and since 1898 we have dismissed, cured 
and improved fifty patients. I have the list with me. 

Mr. Snyder. Is there any member of the committee who desires 
to ask any questions? 

Q. (By Mr. Hall.) Have any of those returned that were dis- 
missed? 

A. Two out of the list. 

Q. This building is some little distance from the other building, 
or is it a part of it? There is a group here but I can't distinguish 
them (referring to photograph). 

A. The second story is set apart entirely for the insane and this 
passageway here is for bringing the female insane down to this 
dining room so they do not come in contact with those inmates in 
those corridors (referring to photograph.) 

Q. It is a private almshouse? 



122 

A. Yes, sir; they have a separate dining room there; sleeping 
rooms and sick rooms are all separate but in that same building. 

Q. They don't mingle with the other inmates at all? 

A. Xo, sir; only in certain lines of work, in the laundry and sewing 
room. 

Q. But not in a general way? 

A. Xo, sir. 

Q. Did you say that $2.42 was the cost per capita per week? 

A. This last year it averaged $2.16; of course that is not the net 
cost. We have considerable receipts and it brings it down; that 
is exclusive of the State aid; take off the State and it brings it down 
per capita to a minimum. All the money we receive we pay into 
our county treasury, and draw all the money we expend on the 
county treasurer. The net cost to the county would only be about 
91 cents per week. I have a report here explaining the matter in 
full which I will be glad to leave with you. 

Q. (By Mr. Snyder.) Will you kindly file it with the secretary? 

A. Yes, sir. 

Q. Then your patients have different lines of employment? 

A. Oh, yes; we employ all the male and female patients at various 
kinds of work; we employ the females at such work as in the laun- 
dry, sewing and dining room work and employ the men on the farm. 

Q. Are they better off for having employment? 

A. Very much better off and better behaved on account of it. 

Q. (By Mr. Marshall.) Are they acute cases or chronic? 

A. All kinds. 

Q. (By Mr. Hall.) Have you some that are necessary to keep con- 
fined? 

A. At times we have. 

Q. (By Mr. Snyder.) Have you any patients from your county in 
any State institution? 

A. Yes, sir; there are several on the list of the directors of the 
poor at the Harrisburg asylum and two at Warren. 

Q. Are they violent cases? 

A. Those cases at Harrisburg? 

Q. Yes, sir. 

A. Well, I don't know that they are; there is one that is a homi- 
cidal case and these cases are cases that their friends wanted kept 
there and they pay, that is, a majority of them pay the county $1.75 
a week for having them kept there and the directors of the poor 
did not insist on bringing them back. 

Q. Couldn't you take as good care of violent patients as the State 
institutions do? 

9. Well, T wouldn't say that we could take as good) care of them, 



123 

but we had to do it not because we desired to but from the fact 
that we couldn't always get them admitted to the State institutions, 
and after keeping them there for a certain time they would quiet 
down. That has been our experience ija nearly all those cases, not 
that we desired to keep them, because they were very annoying at 
times. 

Q. How many males and how many females have you in your 
institution, of the insane? 

A. I think we have three more males than females; they are 
pretty equally divided at the present time; that is, of the insane 
patients. 



Mr. Snyder, Chairman'. The next on the list is the Cumberland 
County Hospital for the Insane, at Carlisle, Pa., Francis Metzger, 
superintendent. 

There being no response the next on the list is the Chester County 
Hospital for the Insane, Embreeville, Pa. 

Dr. Jane R. Baker called and testified as follows: 

Examination conducted by Mr. Snyder, chairman. 

Q. You are the superintendent of the Chester County Hospital 
for the Insane at Embreeville? 

A. Yes, sir. 

Q. How many patients have you in the insane department? 

A. One hundred and seventy-four and those out on visit. 

Q. How many males and how many females? 

A. I have 97 males and the rest females. 

Q. How many attendants per capita? 

A. I have just four patients over ten apiece. 

Q. Has there been an estimate made, separate from the cost of 
keeping the paupers of the county, as to the cost? 

A. Yes, sir; we keep the books separate. The cost last year was 
|2.80 a week. That, I think, you could say was hardly the full cost 
because the teaming and hauling of coal and everything of that kind 
is done by the county home, but that we did not keep an account of. 

Q. That which is raised on the farm, is that included? 

A. Yes, sir; we get that at five per cent, below wholesale prices 
and that is so because the men work on the farm. 

Q. As I understand, the two departments are kept entirely apart? 

A. Yes, sir; three hundred yards apart. 

Q. How about their accounts? 



124 

A. Everything is separate. 

Q. What is the requirement for the admission of patients into 
your institution? 

A. I have an application blank on which are about ten or fifteen 
questions which is sent to an applicant and as far as possible I never 
take any one who I can't find out something about before taking 
them. I write to people whom I know in the community from which 
they come, and so on. 

Q. And it also requires a certificate from the directors of the 
poor? 

A. You mean patients, I though you had reference to the attend- 
ants. The admission of the patients is practically the same as it is 
with the State hospital, in addition to having an order from the 
directors of the poor. 

Q. You employ all the help, both male and female? 

A. Yes, sir. 

Q. Your supply of food is procured through the steward? 

A. I make out once a month a requisition for dry goods and sup- 
plies and they are purchased by the steward with the assistance 
of one of the directors, and every day I make out a requisition for 
perishable goods and that is filled. 

Q. What arrangements have you in case of an outbreak of fire? 

A. We have chemical fire extinguishers; we have hose and fire 
escapes. 

Q. On the outside of the building? 

A. Yes, sir. 

Q. What arrangements have you in case of epidemics? 

A. The poorhouse was run for years and they have a stone build- 
ing which was always used as a contagious ward and it has been 
used once since the insane have been there. That building was 
arranged so we could take care of the insane and this winter a pest 
house was built and both of them could be used at any time for the 
insane. 

Q. What system have you in use for the discharge of patients? 

A. The same as the State hospitals. 

Q. You have a system of parol in certain cases? 

A. Yes, sir; I have six patients now on parol, away from the in- 
stitution. 

Q. Is this institution as well provided to take care of violent 
patients as State institutions? 

A. I have worked in two institutions and I consider that we are 
as well able to take care of them as those I worked in. There is 
only one exception, that is. in a hospital with two wards you are 
not as able to divide your patients as in a hospital with eight or nine 
wards; that is the only criticism I could make under that head. 






125 

Q. There are few patients from Chester county in any State hos- 
pital at this time? 

A. We have one at Wernersville and two at Norristown. 

Q. Why is one at Wernersville? 

A. We have a father and son and the history is that when they 
are together it annoys them and the decision of the board was that 
they would not accommodate them at the same institution. The 
cases at Norristown are paid and it is preferable to care for them 
there instead of in a smaller institution. 

Mr. Snyder. Has any member of the committee any questions 
to ask? 

Q. (By Mr. Hall.) Was this building constructed especially for 
the insane? 

A. Yes, sir. 

Q. How long ago? 

A. It was started on the 15th of March, 1900; opened! at that 
time. 

Q. Is it a frame building? 

A. It is a fire proof building as far as it is possible to build one. 

Q. You speak of being connected with other institutions. What 
other institutions were you connected with? 

A. One in Massachusetts, one at Northfield. 

Q. You say that this hospital, over which you are superintendent, 
was as suitable for the care of the insane as a larger one? 

A. Yes, sir; of course very small institutions lack in some things 
that you get in a larger one and a small one also has some advan- 
tages that the larger ones do not have. You can give them more 
attention in a smaller one but not as much entertainment. 

Q. Have you an assistant physician? 

A. I have no assistant; I have two physicians, one a male and 
one a female, and one of them comes in the middle of the day and 
one will call later to see if anything is needed. 

Q. You have about twenty nurses? 

A. Yes, sir. 

Q. (By Mr. Bliss.) How often does the Board of Charities visit 
your institution? 

A. Dr. Wetherill has been there as often as twice a year and 
sometimes three times and a representative of the State Board of 
Charities once a year. 

Q. What have you to say of the benefit of the State Board of 
Charities? 

A. They have been very kind to me. 

Q. It is rather an embarrassing question? 

A. Yes, sir; when people have been very kind to you. 



126 

Q. (By Mr. Snyder.) What does the State Board of Charities 
attempt to examine when they visit your institution? 

A. When he comes he goes all over the institution, went over my 
books, went over everything I was doing and I think made a pretty 
thorough investigation of the way I started and conducted the hos- 
pital. I felt that it was a very thorough examination. 

Q. You have a system of employment for the inmates? 

A. Yes, sir; I keep them just as busy as I can. 

Q. And all who are able to attend to any kind of duties are as- 
signed them ? 

A. They are encouraged to do them; we don't make any person 
do anything, but we try by encouragement and almost bribe them. 
I sometimes pay them when I want them to do something; it makes 
them feel like other persons. 

Q. There are very few who are not able to take care of something? 

A. Very few; I have sixty-five at present who are busy at some- 
thing. 

Q. Explain to the committee what they are doing. 

A. The men are working on the farm doing everything that a man 
has to do on the farm, except handling the team, working in the 
garden, clearing up rubbish and doing every little thing we can 
find for them to do outside. The women are sewing, ironing and 
are making their own clothes and a good part of the men's clothes. 

Q. (By Mr. McClain.) How many years experience have you had? 

A. Ten years, all but about a month. 

Q. In your opinion is it a better plan to maintain a large number 
in a large institution than to have a smaller number in a small 
institution, or do you think it is best to have them in a large insti- 
tution, like at Norristown, where they have twenty-two hundred? 

A. I don't know anything about that; I couldn't do that very 
well. 

Q. In your opinion from which do you think the best results are 
obtained, in one large institution with 2,200 inmates, or two institu- 
tions with 1.100 each? 

A. My experience has been. I was in an institution where there 
were five or six hundred and then I went to an institution where they 
had eleven hundred, and I consider that the best work was done 
where there were between five and six hundred. The difficulties 
we had with the larger number was not there and the difficulties 
that I had with the smaller number were not there, but I think the 
smaller one was the most successful. 

Q. (By Mr. Hall.) You have 170 patients in your institution? 

A. One hundred and seventy-four. 



127 

Q. How many require medical treatment, of course we know 
there are a great many who don't require it? 

A. 1 think any person who is insane needs medical care, needs 
medical watching. For instance, I have them weighed every month; 
many of them I don't know what is the matter and weighing them 
I get a pretty good idea of their increase or decrease and in that 
way of their physical disease. 

Q. How many patients who are insane are you able to see every 
day and prescribe for them? 

A. I don't think they are well cared for unless I see them all 
every day. That is not very many, not after having eleven hundred. 

Q. You had some assistants when you had that number? 

A. Only one. 

Q. Wouldn't eleven hundred be a good many for two doctors? 

A. It keeps you very busy. 

Q. I think far too much? 

A. I did too. 

Q. I don't speak from experience but I wouldn't like to be one of 
the eleven hundred? 

A. I wouldn't either. 

Q. (By Mr. Snyder.) What are the advantages of a county hospital 
over a State institution? 

A. Nothing; the size is the only thing. 

Q. (By Mr. Bliss.) Do you think there would be any advantage 
in having a central board which would have authority over all the 
county institutions, something more than the Board of Charities? 

A. The Board of Charities is very good; it needs more help. 

Q. Does the Board of Charities do anything more than simply 
advise you? 

A. If I was in difficulty I should turn to the Board of Charities 
for advice and assistance. 

Q. Don't you think it would be an advantage if all the county 
institutions were placed under one central board and that board 
prescribe the management as well as furnish the supplies to the 
different institutions so that there would be a uniform management 
and that the experience of the larger counties could be taken ad- 
vantage of by the smaller ones? 

A. I think you would find it pretty difficult to arrange it in that 
way. 

Q. I understand that is the system in use in Wisconsin? 

A. I have looked it over but not careful enough to give any 
opinion about it at the present time. I think constant visiting from 
the outside is a great assistance and I find that the visitor who comes 
to us once a month is a great help to us. 



128 

Mr. Snyder, chairman. The next on the list is the Hillside Hos- 
pital for the Insane, located at Clark's summit. 

George W. Beemer called and testified as follows: 
Examination conducted by Mr. Snyder, chairman. 

Q. You are the superintendent of the Hillside Hospital for the 
Insane? 

A. Yes, sir. 

Q. How many inmates have you in your institution? 

A. Two hundred and sixty-one. 

Q. How long has it been in operation? 

A. Since 1862, I think, as an institution. 

Q. Not as an insane institution? 

A. No, sir; I think about 1882 is when they began to care for then 
insane, either in 1881 or 1882. I came there in 1883, and they had 
been doing so two years, or nearly that time. 

Q. What has been the cost, per capita, for the maintenance of 
your inmates? 

A. It varies from $3.25 to $2.75. 

Q. That is the cost, per capita, per week? 

A. Yes, sir; it varies, of course. 

Q. Are you able to draw any supplies from the farm, or from an^ 
other source connected with your institution? 

A. Yes, sir; we raise a great deal of the supplies. 

Q. Is that charged in with the account? 

A. Yes, sir. 

Q. In other words, that would be about the cost if you had to buy 
everything? 

A. Yes, sir. 

Q. What protection have you in case of fire? 

A. We have a special, or water line, controlled by an automatic 
engine operated in the power house; we also have a two inch con- 
nection in each ward on each floor, in every ward. 

Q. What protection have you in the case of an outbreak of any 
contagious or infectious disease? 

A. Well, we have so far never had anything of the kind. We 
could isolate them in some remote part of the building. In connec- 
tion with the insane department there is an epileptic building and 
the upper floor of that could be utilized very well for contagious 
diseases. At the present time we are not using it very much. 

Q. How many physicians have you? 

A. One physician. 

Q. How many nurses have you? 



129 

A. We have at this time nineteen nurses, including our night 
nurses. 

Q. Are there about the same number of patients among the males 
and females? 

A. There are about ten more females at this time than males. 

Q. Are you taking care of the violent patients as well as can be 
taken care of them in the larger institutions? 

A. Yes, sir; so far as we have taken care of them very well. ^ 

Q. You have no patients in any of the State institutions? 

A. I think at this time we have one in the Danville hospital; that 
patient has been turned over and charged on our district but has 
been a pauper patient for sometime. 

Q. There is no particular reason why you should not take care 
of that patient? 

A. No, sir. 

Q. Have you a system of employment for the inmates? 

A. Yes, sir; we have. 

Q. They are nearly all employed in some way? 

A. Yes, sir; we try to give them employment at something which 
has been their natural avocation in life before they were insane. 

Q. How many visits do you receive from the Committee on Lu- 
nacy ? 

A. Usually two or three times a year. 

Q. How many visits do you receive from the Board of Public 
Charities? 

A. About the same, perhaps a little oftener. During Mr. Boyer's 
administration he used to get up and see us quite often. 

Q. Do you know of any cases admitted to your institution on 
the ground of insanity, who were not insane? 

A. I do not, no, sir. 

Q. Have you amusements in your institution for your patients? 

A. Yes, sir; we have amusements of various kinds. We have a 
hall specially fitted up for that purpose. 

Q. Have you any system of religious observance in your institu- 
tion? 

A. Yes, sir; every week. 

Mr. Snyder. Has any member of the committee any questions 
to ask? 

Q. (By Mr. Hall.) Have you any patients there taken from the 
State insane asylum and brought to your institution after your in- 
stitution was in existence? 

A. Only the time the fire occurred at Danville, or soon after, a 
few were brought there and since we have aimed to take care of 
them. We have at this time sixty-nine patients that do not belong 



130 

to our district; they belong to different counties, such as Pike, 
Wayne, Wyoming, Susquehanna and Bradford; we have some there 
from these counties. 

Q. Admitted there by the local county authorities? 

A. Yes, sir. 

Q. (By Mr. Bliss.) How do you think you compare with the State 
institutions in the care of the insane? 

A. Pretty fair; very good. 

Q. Do you think it is as good as in the State institutions? 

A. We think we will compare fully as well. 



Mr. Snyder, chairman. The next on the list is the Elk County Hos- 
pital for the Insane, at St. Mary's Pa., J. W. DeHaas. There being 
no response, the next on the list is the Erie County Almshouse. 
Erie, Pa. ; Z. W. Zuck, steward. Mr. Zuck presents a written state- 
ment, which will be filed with the secretary. 

The next on the list is the Franklin County Almshouse, Chambers- 
burg, Pa., Jacob Potter, Steward. 

There being no response, the next in order is the Jefferson County 
Home, Brookvilie, Pa., represented by the county commissioners. 
Is there any member of the board of county commissioners present? 

There being no response, the next on the list is the Central Poor 
District of Luzerne County Hospital for the Insane, located at 
Eetreat, Pa., Dr. Charles B. Mayberry, superintendent. 

Dr. Charles B. Mayberry testifies as follows: 

Q. How long has the Central Poor District of Luzerne County 
Hospital for the Insane been established? 

A. It was opened in 1900. 

Q. How many patients have you in this institution at this time? 

A. Four hundred. 

Q. Are they all patients from Luzerne county, or some from the 
adjoining county? 

A. We have them from several counties; we have about eighty out- 
side of our district. 

Q. What is the cost per capita for the maintenance of the patient 
per week? 

A. About three dollars. 

Q. Have you any resources to draw from, except what you buy 
outside? 

A. Do you mean as income? 



131 

Q. No, have you a farm? 

A. Yes, sir; there is a farm that belongs to the almshouse. We 
have nothing to do with that. 

Q. In estimating the cost at $3.00 do you put a value on what you 
get from the farm? 

A. Yes, sir; we allow to the almshouse a proper amount for that. 

Q. What provision have you in your institution in the case of an 
outbreak of fire? 

A. We have outside hydrants, pressure of eighty pounds, out- 
side standpipes, chemical fire extinguishers, standpipes running 
through all sections with hose in each ward. We also have inside 
fire-proof iron staircases as well as outside iron fire escapes. 

Q. What provision has been made in the case Of an outbreak of 
any contagious or infectious diseases? 

A. There is a small pest house on the grounds which has never 
been used; it belongs to the almshouse. But our ventilating system 
is such that in case of a contagious disease I believe it is possible to 
segregate them properly in the wards. 

Q. How many physicians have you in your institution? 

A. One besides myself. 

Q. There are two there all the time. 

A. Yes, sir. 

Q. How many nurses? 

A. One to ten right through, on both sides. 

Q. What is the source of your water supply for drinking pur- 
poses? 

A. Spring water pumped into a tank holding one hundred thou- 
sand gallons, which is located back of the buildings on a hill. 

Q. How often does the Committee on Lunacy visit you? 

A. Dr. Wetherill has been there about twice a year and not infre- 
quently there is some one with him. Mr. Biddle is there once a year. 

Q. Your system of commitment is the same as the others who 
have made statements here to-day? 

A. Yes, sir; exactly the same. 

Q. And your system of discharge is also similar to that which has 
been stated? 

A. Yes, sir. 

Q. Do you give your patients work to perform? 

A. Yes, sir; we have from 50 to 60 per cent, who work all the 
time. There are many physically unable to work but all we can 
work we have do some kind of work. Of course it is an important 
part of the treatment. 

Q. The food supply, I presume, is obtained through the board of 
directors? 

A. We advertise for it three or four times a vear for the more im- 



132 

portant part of our supplies. It is very much like the supplies fur- 
nished to the Slate insane hospital. The almshouse and hospital 
are kept separate and each account is kept separate and our food 
supplies are advertised at the same time, certain parts being for 
the almshouse and certain parts for the other department, the two 
being wholly distinct and in fact we have no connection whatever. 

Q. What is the capacity of your institution? 

A. We have at the present time four hundred, and that was the 
estimated capacity when it was put up in the first place, but we have 
450 beds put up now and we can very easily accommodate 450. 

Q. Without injury to the patient? 

A. Yes, sir; but my plan has been to urge detached buildings, 
which will come soon and enable us to make a better classification. 

Q. Do you think it would be an advantage to have meetings of 
all the superintendents several times a year in order to discuss the 
best methods for the treatment of the insane, similar to what is 
being done in New York state among its superintendents? 

A. I think the New York system, in that respect, is very good. 
I find myself, and most people no doubt do, becoming narrow minded 
and getting into ruts and this could be largely overcome by contact 
with others; therefore, I think this method has a tendency to the 
broadening of the mind and I think nothing but good can come 
from it. 

Q. What do you think of the New York system of control? 

A. I do not believe in it because I think it would result in too 
great centralization of power. Without any desire to criticise Dr. 
Wise at all, I can hardly refrain from mentioning his removal, 
which occurred a few months ago, which shows that even an eminent 
alienist has been moved by such power and may do things which 
under our system would be impossible. 

Q. You believe in home rule? 

A. Yes, sir. 

Q. What is your method in obtaining nurses? 

A. I send out blanks to those who make applications and re- 
quire three references; those references are written to and if the 
recommendation seems favorable I have personal interview and the 
result, if the interview is favorable, is his appointment. Under the 
best system we get many who are unfit. The difficulty is that we 
do not pay enough. We pay a little more than the State hospitals. 
My experience covers about eleven years in State hospital work 
and the same difficulty occurred there that I have now. I think on 
account of the present times it has been harder to get desirable 
young men, say in the last two or three years, than it was fifteen 
years ago. I have no trouble among the female class but the pay is 
not enough to induce desirable young men to take the positions. 



133 

Q. What do you pay? 

A. We start in the males at |18 and gradually increase them to 
$25 if they reach the position of heads of wards. And if at the end 
of two years they graduate from the training school they are in- 
creased to $28, which is the maximum. This, of course, does not 
include the supervisors. That is as much as they get at Danville 
after five or ten years' service. 

Q. Do you not believe that so far as it is possible the application 
of correct civil service principles for the employ of assistants in 
the various hospitals would be beneficial? 

A. I think civil service rules in the medical department might 
answer very well, but what we pay at the present time I don't think 
we could work civil service rules for the employment of the at- 
tendants. 

Q. Suppose the salary would be increased in proportion to the 
demands of the times would there be any advantage over the present 
method of appointment? 

A. It would be among the higher classes of service but not the 
attendants. Of course, I assume that examinations are included 
in civil service as they have them in New York. 

Q. (By Mr. Bliss.) How do the results of the treatment in your in- 
stitution compare with those in the State institutions? 

A. I think there are about the same proportion of recoveries. Our 
percentage of recoveries has been quite as high as in the State in- 
stitutions. I think it is as high as it can be in the treatment of the 
insane, under the present system. 

Q. Is there as much visiting in the county hospital as there is in 
the State institutions? 

A. Yes, sir; very much more; that is because it is nearer the centre 
of population. 

Q. Is it better to have a few large hospitals throughout the State 
and a large number of patients in them than to have a good many 
small hospitals scattered around through the State containing say 
five or six hundred inmates? 

A. That is very difficult to answer. You mean a hospital to treat 
all classes? If that is what is meant I think the smaller they are 
the better. If, however, you mean institutions for the treatment 
of the chronic insane, or rather for the care of the chronic insane as 
separate institutions for the treatment of the acute insane, I see 
no objection to increasing them to several thousand; but if the 
acute cases are to be centred in among the chronic cases the smaller 
the number the better the results will be. I have never seen any 
good come to the curable ones by contact with the chronic insane. 

Q. You are familiar with the separate treatment of the chronic 
insane at Wernersville? 



134 

A. Yes, sir; I am but we have no such condition in this State as 
at Wernersville. 

Q. Is it wise to continue that policy? 

A. I think Wernersville is putting the cart before the horse. 
The object was to relieve the State hospital in the building of 
that institution. I was in one of the largest and most crowded 
hospitals at the time it was built for years before and years after 
it was built and the relief from it amounts to nothing whatever. 
What should have been done was not to increase the space for the 
chronic cases because we already had sufficient space for the reason 
that every hospital was fitted for chronic cases and nothing else. 
What we should have done was to build a hospital for the acute 
curable cases and nothing else. The Wernersville hospital plan 
was tried in New York and abandoned years ago. What we want 
to do is not to prepare a patient for Wernersville but we want to 
cure him and send them out to their homes and friends. By putting 
six or seven hundred thousand dollars in Wernersville we delayed a 
quarter of a century in the proper advancement in the treatment of 
the insane for it diverted this money from the cure of the insane to 
preparing a place for the results of the unfortunate systems in 
vogue in the State hospitals which are largely training schools for 
Wernersville. In the last report of the 'State Lunacy Commission 
of New York Dr. Peterson suggests what was suggested a good 
many years ago and at that time was regarded as absurd and impos- 
sible, that there should be small receiving hospitals for the imme- 
diate treatment of the acute curable insane separate from the 
hygenic environments of the large asylums of chronic cases and we 
will never reach the best results in the cure of the insane until such 
a system is adopted. If you cross the water and visit old Bethlam, 
the Bethlam of old, with all its unfortunate associations you find 
better results and more cures than even in the palatial Morningside 
and Dumfries, for the simple reason that the former is devoted to 
the acute curable insanity without chronic associations and the 
latter have their few curable cases for treatment in among their 
hundreds of chronics. I know that every gentleman here who has 
had long experience in the treatment of the insane will agree with 
me when I say that I have seen cases that have been made chronic 
simply as a result of contact with chronic cases. Suppose a man has 
a delusion of having done some wrong, of having committed the 
unpardonable sin for instance, or done some great wrong against 
God and he comes in contact with a case similar to those ideas 
the result is almost sure to be a strengthening of the delusion. I 
have had such patients and I am quite sure that every one with 
long experience among the insane have noticed similar unfortunate 



135 

occurrences. Strong friendships are formed between patients with 
similar mental conditions and great influence of the one over the 
other results. 

Q. Is not that more likely to occur in the county institutions than 
in the State hospitals? 

A. No, sir; I think it is less because we have a less number of 
chronic cases. I believe the smaller the institution the better. Im- 
agine for yourself an insane patient with an acute depression sud- 
denly brought in contact with hundreds of homicidal, suicidal, degen- 
erate and criminal classes and you can see what the natural in- 
fluence would be upon this weakened mind. Imagine a woman, 
brought up in refinement, retiring in disposition, whose very nature 
in health would shrink from contact with such characters and the 
result, reason will tell you, is the most detrimental to her mental 
restoration. With but few cases in the acute hospital such detri- 
mental contact could be avoided. With the best classification of 
the few cases of curable insanity scattered in the State asylums, 
among the hundreds of chronics, avoidance of this contact is impos- 
sible. Imagine such a thing as being brought into association with 
epileptics, with homicidal, suicidal, degenerate and criminal patients. 

According to the last report of the Committee on Lunacy we have 
less than five hundred curable cases in the State hospitals. If there 
were a half dozen hospitals to hold seventy-five or eighty patients 
apiece it would include the whole State. It is not necessary to 
have expensive buildings but they should be equipped with every 
means for utilizing the usual methods of treatment for nervous as 
well as mental diseases. They should be equipped for all means 
of utilizing hydropathy, massage, surgical and genealogical treat- 
ment and every means known to science to bring the patient's final 
condition to a normal one. Through this alone is mental recovery 
possible. The means for utilizing such special forms of treatment 
are entirely inadequate in the State asylums. I have myself served 
as a physician in a State hospital for eleven years, in which, in case 
of difficult labor, it was necessary to send to an adjoining town to 
borrow a pair of obstetric forceps, and I have held the trachea in 
a case of operation for a foreign body open with a pair of scissors 
until a colleague could bend a glass tube to insert in place of 
tracheotomy. 

Q. What is your opinion about the' establishment of a criminal 
insane hospital? 

A. That would be one step forward. Do you mean to put cases 
where they commit crime and are acquitted on the ground of in- 
sanity and the hardened, low degraded criminal, who become in- 
sane, together? 



136 

Q. How large should it be? 

A. There is a difference. If you limit to the convicts the number 
will be very small, but if it is to include all classes it should be large 
enough to hold four to five hundred, future needs being considered. 

Q. (By Mr. Hall.) The question was asked you with reference to 
smaller hospitals holding five or six hundred and now then you 
would establish another hospital for the criminal insane and thus 
classify them again. Wouldn't that be liable to get too many 
different kinds of hospitals in such ramifications? 

A. I don't think there would be any difficulty. The system would 
consist, if carried out as I suggest, of, first, the present State in- 
stitutions which would be the chronic asylum. Second, a single 
criminal insane hospital. Third, the acute psychopathic hospitals, 
and fourth, a hospital for epileptics, if such were adopted. New 
York has all of these except the acut psychopathic hospital and 
that is now proposed. The cases of acute insanity, where crime has 
been committed because they were not admitted to the hospital 
sufficiently soon are not responsible but society is, and I would treat 
them just as any other cases of acute insanity. A few years ago 
a prominent physician in Pennsylvania committed murder simply 
because a community, knowing him to be insane and dangerous, left 
him at large without treatment and thus made it possible for such 
a crime to be committed. He was not a criminal nor was he respon- 
sible and responsibility, if it exists at all, is on the part of those 
around him. The insane convict is frequently a degraded degen- 
erate, who, having committed crime under prison confinement be- 
comes actively insane. In the first case the criminal instinct is 
lacking and insanity is the cause. In the second case, the criminal 
tendencies are present from birth and insanity supervenes as the 
result of environment. 

Q. Could there not be departments constructed at the present 
hospitals for the accommodation of such patients? 

A. I think the association of the great institution for the insane 
is a bad one to have connected with acute curable cases. It 
sticks to them when they go outside and nine cases out of ten does 
them harm. 

Q. State whether or not this psychopathic could be established 
in connection with the present large asylums. 

A. This might be done and would be one step forward but the 
plan I have suggested is preferable because it removes the associa- 
tion of the asylum, a name indelibly connected with large State insti- 
tutions and one which is extremely detrimental to the cured case 
after discharge. 

Q. (By Mr. Snyder.) What is the distinguishing line in reference 
to chronic insane and acute cases? 



137 

A. Do you mean where the line of demarcation is? 

Q. Yes, sir. 

A. We usually consider a case chronic after one year's duration 
but many are essentially chronic from the beginning, as the case 
of organic brain disease, of arrested development, idiocy and im- 
becility and epileptics and those with certain hereditary taints. 
It is easy to tell clearly what the acute cases are; they are certain 
forms of cases where the disease is functional, without demonstra 
ble brain lesions and usually where the mental trouble results 
renexly from bodily disease, which admit of a possibility of restora- 
tion. These are the acute curable cases and these are the cases 
which science and humanity call for different treatment. 

Q. In other words, they are only a little off? 

A. Yes, sir. 

Q. What are the requirements for the admission of patients to 
Wernersville? 

A. They must be quiet chronic cases, good workers, in good bodily 
condition, clean in their habits, not suicidal, homicidal or epileptic. 

Q. (By Mr. Hall.) What is the capacity of Wernersville? 

A. Eight hundred is the capacity. 

Q. And how many have they? 

A. They have from seven hundred to eight hundred and fifty. 

Q. That is an asylum for the chronic insane? 

A. Yes, sir. 

Q. How many cases are there in the State hospitals that are 
curable cases? 

A. There are about six thousand patients in the State hospitals 
of Pennsylvania and according to the estimate of their medical 
officers there are less than five hundred cases which are curable. 

Q. Can you take as good care of the criminal insane in your hos- 
pital as can be taken of them in the State institutions? 

A. Yes, sir; I think so. Our building has cost us about one thou- 
sand dollars per capita. 

Q. And it has cost about four hundred thousand dollars? 

A. Yes, sir; with the furnishings. It has a thorough hospital 
organization and it is not inferior in any way to the State institu- 
tions and in some ways is superior. 

Q. (By Mr. Heidelbaugh.) What is your opinion as to the epileptic 
insane? 

A. I think there should be a separate institution for them. New 
York has one, Massachusetts has one and some other states. That 
is a movement in the right direction. You gentlemen may think 
that I am suggesting something which would be extremely expen- 
sive, but think of taking care of an insane patient for forty years 



138 

and then think that you might have taken care of that same patient 
only three months with proper treatment, and the possible pauper- 
ism of all his family, I think you will see that the expense to the 
State would be very great in the number of years that I have men- 
tioned and that almost any expense for cure might properly be born 
rather than to support him for years as a chronic lunatic. Further- 
more, if this system were introduced the present per capita cost 
for the chronic cases in the State asylums would be much less than 
it is now; for, while it is inadequate for the proper treatment of 
the acute curable cases, it is unnecessarily large for the proper 
and humane care of the chronic insane. The attendants, which 
average about one to eight in the State hospitals, need not be 
nearly so great for the care of the chronic cases and should be 
very much larger for the acute cases. The attempt, therefore, to 
have the asylum for both class of cases is unnecessarily expensive 
in the one and totally inadequate for the other. 

I would like to say, before finishing my remarks to the legislative 
committee, that I feel that a difference should be made in the amount 
of maintenance from the Commonwealth for a hospital like that 
at Ketreat, which is organized on a thorough basis in every way 
as exclusively as the State hospitals and the almshouses which 
accommodates in its buildings a few chronic insane. 



Mr. Snyder, chairman. Is Mr. Colbourn, treasurer of the Somer- 
set County Hospital for the Insane, present. 

L. C. Colborn testifies as follows: 

I have been one of the directors of this hospital, watched over it 
since its infancy and know the workings of it about as well, or a 
little better than any other person. Therefore, at the request of 
our board of directors and the superintendent, I am here to answer 
any questions that may be asked me. 

Examination conducted by Mr. Snyder, chairman. 

Q. What is the capacity of the Somerset County Hospital for the 
Insane? 

A. One hundred. 

Q. Have you a physician connected with the institution? 

A. Yes, sir. 

Q. Is he constantly in attendance? 

A. He does not reside there but he visits there, according to our 
rules, every day and he is in telephonic connection with it. 



139 

Q. He is engaged in the practice of medicine? 

A. Yes, sir. 

Q. How many nurses have you in your institution? 

A. Four, two male and two females. Our female nurse was super- 
visor at Dixmont for several years and she is a very excellent nurse. 

Q. What is the cost of maintenance, per capita, at your institu- 
tion? ■■■'. ' i 

A. One dollar and eighty-four cents last year; that was not in- 
cluded in the cost of per capita last year, that is, with what was pro- 
duced on the farm; we produce all our vegetables. 

Q. You say $1.84. 

A. Yes, sir. 

Q. What provision have you made in case of an outbreak of fire? 

A. Our building is two stories high, with finished attic, and closed 
fire escapes and four stairways. 

Q. Are the fire escapes on the outside? 

A. Yes, sir; I have some photographs here which I shall be glad 
to present to you (witness produces photographs). This shows the 
fire escape on the male ward and this on the female ward and 
this is the front view of our hospital and this the side view and 
here is a view of our dining room and a view of our second ward 
(indicating the various points of location on the photographs). 
There is a view of the third ward; that is the hospital ward. It was 
established first in October, 1898; we had a building at that time 
39 by 52 for the chronic insane, that we had as a poorhouse at that 
time and at the solicitation of the Committee on Lunacy the directors 
of the poor adopted plans, approved by them, and built a large addi- 
tion to it. 

Q. Have you any patients in any of the State institutions? 

A. Yes, sir; four; one at Wernersville and three at Dixmont. 

Q. Are you prepared to take care of patients in your institution 
as well as they are able to take care of them in the State institu- 
tions? 

A. Yes, sir; we have had several very violent patients but through 
the care of the nurse and physicians in a few days they were quieted 
down. Some patients came there that were very violent and within 
a few weeks they were quieted down and several returned to their 
friends. 

Q. Have you labor for the patients to perform? 

A. Yes, sir. 

Mr. Snyder. Has any member of the committee any questions to 
ask? 

Q. (By Mr. McClain.) In your opinion do you think that the present 
law meets all the requirements that it is intended to meet? 



140 

A. Yes, sir. 

Q. Have you any suggestions to make looking to its amendment 
or improvement? 

A. Only in one respect. In the county care of patients the man- 
agement of the hospital have to make out a financial report at the 
end of every quarter with a statement of the number of inmates 
and so on and this has to be qualified to by the directors of the 
poor, while in the State hospital they do not have to do that, they 
merely have to keep a record of the number of patients they have to 
maintain that quarter, and I don't see why the directors of the poor 
have to qualify to the cost of keeping their insane any more than 
the State hospital. 

Q. How often does the State Board of Charities visit your insti- 
tution? 

A. Once a year; we never had any of the other members except 
one time that Mr. Scott was there. 

Q. You mean that Mr. Wetherill, secretary of the Board on Lunacy, 
visits your place once a year? 

A. Y r es, sir; and Mr. Biddle comes there about once a year. 

Q. What does the county pay for maintenance? 

A. One dollar and fifty cents per week for seventy-two patients. 

Q. What do you think about the State Board of Charity managing? 

A. As far back as 1887, when the association of the directors and 
Board of Charities met in Uniontown they passed a resolution ask- 
ing the Governor to appoint a committee to revive and codify the 
poor laws of Pennsylvania, or rather in the first place asking the 
Legislature to pass a law authorizing the Governor to appoint such 
a commission. Such a law was passed in 1889 and that commission 
consisted of Judge Bo we, of Franklin county; J. Nevin Hill, of Sun- 
bury; Lewis Pugh, of 'Scranton; H. R. McGonigle, of Wilkes-Barre, 
and another, and they remodeled the law and that law was drawn 
up and presented in the Legislature and referred to a committee 
and it never got out of committee. 

Q. (By Mr. Marshall). That was in 1891, and it passed the House? 

A. It pas'sed the House afterwards. The law was amended and 
the first ten sections were stricken out and it was passed and vetoed 
by the Governor in 1897. 

Q. (By Mr. Hall.) Does the State Board of Charities and the Com- 
mittee on Lunacy supervise you at all, that is, is the management 
of your county hospital in any way influenced by what they say? 

A. By the Committee on Lunacy? 
. Q. Yes, sir. 

A. Yes, sir; we think a great deal of Dr. Wetherill and act under 
his instruction and his advice. And Mr. Biddle, who paid us a visit 



141 

last spring, gave us a great many good suggestions which added 
greatly to the management of our hospital. 

Q. Could you get along without the Board? 

A. We haven't tried. 

Q. (By Mr. McClain). You do not regard them as being essential 
for the continuance of your hospital? 

A. With the experience that these gentlemen have had and the 
observations they have made I think they could be of very great 
service. 

Q. Are they? 

A. That is asking me a direct question. 

Q. (By Mr. Bliss.) State whether in your judgment the establish- 
ment of a board of control with a man like Dr. Wetherill at the 
head of a department, having absolute control over all the insti- 
tutions of that kind in the State, with the advice and assistance of 
local boards, would not have a beneficial effect in making those 
institutions more useful to the State than under the present 
system? 

A. Yes, I think so. I am very greatly in favor of the county care 
act and I think as time passes by it will demonstrate to the public 
that it is a very proper thing, that is, the county care system of 
taking care of the insane. I have visited nearly all the hospitals 
of this State and have been in a number of the hospitals under 
the county care act and I must say that I am very much impressed 
and pleased with the system. 

Q. (By Mr. Hall.) You think then that where you have some sort 
of outside supervision, that is, some one coming in from the outside, 
that it is a benefit? 

A. Yes, sir. 

Q. You would not advocate the county institutions left to their 
own control and conduct? 

A. No, sir; the only difiiculty is its retrograding effect on the basis 
of the county homes. Judge Barker, of Cambria county, came to see 
me on account of that and said that was the only reason he did not 
encourage the directors of the poor to establish an asylum in their 
county for the chronic insane because of the fear that, without any 
outside assistance, it would soon retrograde into a county home. 

Q. (By Mr. McClain.) In your opinion do you think that where in- 
sane patients are taken from the State insane asylum and placed 
in the county asylums that they improve more rapidly there? 

A. Yes, sir; I think they do better when they are among their 
friends, and I think it is better from the very fact of their being 
near home and that it has a tendency to cure more than the 
medicine of doctors. Another thing, I heartily approve of the 
question you asked several on the stand here with reference to 



142 

whether it would be a benefit to having a conference of superintend- 
ents twice a year, or the management of these hospitals, where they 
could exchange ideas with reference to the management of such 
institutions and make suggestions for the government and control 
of these hospitals. The association for the charities of the State 
was organized in 1886, and the improvement of the county homes 
is the outgrowth of that association throughout this State more than 
anything else. Professor Gould, or E. P. Gould, who is the president 
of our association, has been connected with it for years and I believe 
he would bear me out in that statement. I have the financial report 
for the last year and also the report of the rules and regulations 
of the association which I will gladly leave you if you desire it. 



'Mr. Snyder, chairman. I will now call upon George W. Wilson, 
director of the Pittsburg City Home for the Insane. 

George W. Wilson testifies as follows: 

Examination conducted by Mr. Snyder. 

Q. You are the director of the board of charities for the city of 
Pittsburg? 

A. Yes, sir. 

Q. How many institutions are there in your district? 

A. Just the almshouse and the insane asylum. 

Q. For the city proper? 

A. Yes, sir. 

Q. How many inmates are in the insane department? 

A. Four hundred and forty-nine yesterday morning. 

Q. All from Allegheny county? 

A. No, sir; from the city of Pittsburg. 

Q. You have no inmates from the county? 

A. No, sir ; none. 

Q. What is the cost, per capita, to maintain the insane patients? 

A. Our average for the last year was $2.78. 

Q. You have no farm? 

A. Yes, sir; but that is charging the products of the farm at 
current rates against the maintenance of the inmates. 

Q. What provision have you in the case of an outbreak of fire? 

A. We have a fire escape from each of the wards. We have stand- 
pipes and hose in each of the houses, 250 feet of hose in each of the 
wards and a water pressure of 50 pounds on those standpipes all 



143 

the time, and in addition to that we have a fire department organized 
from our own attendants. 

Q. Can you take care of your patients in case of a contagious 
or infectious disease breaking out? 

A. Yes, sir; we have an isolated hospital and never had occasion 
to use it but once. Our steward uses it as the front part of his 
dwelling house. 

Q. Are your patients employed? 

A. About one-half of them work. All the farm work is done by 
the male patients and all the laundry work, the making of all the 
garments and all the sewing is done in the institution by the fe- 
males, except the making of the men's clothing. 
Q. How many physicians have you? 

A. Three; we have a resident physician and assistant resident 
physician, and then a young physician whom we change every year 
or every two years. 

Q. How many nurses do you have? 
A. One to every twelve inmates. 

Mr. Snyder, chairman. Has any member of the committee any 
questions to ask? > 

Q. (By Mr. Hall.) Does the State Board of Charities visit your 
institution regularly? 

A. Dr. Wetherill and Mr. Biddle, and some members of the State 
Board of Charities, average about one visit a year. 
Q. How large a farm have you there? 
A. Three hundred and thirty-eight acres. 
Q. Is it pretty well under cultivation? 
A. About 250 acres under cultivation. 
Q. Is most of the labor performed by the inmates? 
A. In fact all the labor except the officers in charge of the insane. 
Q. How about the cost of maintenance, is that a matter of reduc- 
tion in expense to the city on account of the work of the patients? 
A. Yes, sir; the average for the year has been $2.78. 
Q. Then from a financial point of view do you consider that satis- 
factory, as a director of the board of charities? 
A. Yes, sir; very satisfactory. 

Q. The building was constructed for that purpose? 
A. Yes, sir; and we are now constructing two of the same plan? 
Q. It is a hospital for the accommodation of patients on a smaller 
scale? 

A. Yes, sir; when those are completed we will be able to take care 
of one thousand. 

Q. (By Mr. Anderson.) What proportion are foreigners? 
A, About 60 per cent. 



144 

Q. (By Mr. Hall.) How many patients have you at Dixmont? 

A. I think about eight patients and we have two patients at 
Wernersville. 

Q. How is your water supply? 

A. Our water supply is now good. It has been very bad. While 
we were taking water from the Chartiers creek it was very bad but 
now we get it through the city mains and we have splendid water 
and it is very satisfactory. 

Q. Would you be willing to go back to the old system and do 
away with the city hospital? 

A. No, sir. 

Q. You think this is an improvement on the old system? 

A. Yes, sir; there is no doubt about that. 

Q. What percentage of recoveries or improved cases, do you recall 
the figures as to that? 

A. I think we have about, Dr. Wilkin, chief resident physician, 
told me we had about 15 per cent, discharged as recovered, or im- 
proved, or restored. 

Q. (By Mr. Marshall.) How T does that compare with the State 
asylum? 

A. I think very favorably. 

Q. (By Mr. Hall.) Have you any suggestions or recommendations 
to make? 

A. Not any, colonel. 



Mr. Snyder, chairman. I now call on Mr. William Good, of the 
Lancaster County Hospital for the Insane, located at Lancaster. 

There being no response, I call on Mr. J. W. Wallace, of the 
Mercer County Hospital for the Insane, located at Mercer, Pa. 

There being no response, I call on any one who is here representing 
the Washington County Hospital for the Insane, located at Arden, 
Penna. 

There being no response, I call on Mr. J. W. DeHass, of the Elk 
County Hospital for the Insane, located at St Mary's, Pa. 

There being no response, I call on Mr. E. P. Gould, of the board 
of charities, of Erie, Pa. 

Mr. E. P. Gould testifies as follows: 
Examination conducted by Mr. Snyder, chairman. 

Q. I suppose you have visited nearly all of the State and many 
of the countv institutions? 



145 

A. Many of theui; some of the State institutions I have not vis- 
ited, but many of them. 

Q. What has been your observation in reference to the State 
institutions as compared with the work of the county institutions? 

A. Well, my observation of the county institution has been so 
limited, until recently, that it would hardly be a fair comparison. 
Pittsburg is taking care of a considerable number of insane for a 
number of years and Philadelphia has taken care of a large number 
of insane for a number of years and some of the other counties have 
some but not as separate institutions but as part of their almshouse 
system and it would hardly be fair to compare it. 

Q. Are you familiar with the system in New York and some of 
the other states in reference to the care of their insane? 

A. I have made considerable study of it. 

Q. Are you familiar with the Williard institution in New York 
state? 

A. Just as I read about it. I remember one question that come 
up to-day. I receive the report every year and attended some of 
the meetings of the association of the superintendents of the poor 
in York state. In York state they have one superintendent of the 
poor in each county and do not have a board of directors of the 
poor or county commissioners we have in this State, but they have 
a superintendent over each county. They meet once a year and 
the State Board of Charities meet with them and hold a convention. 
About eight years ago there come up quite a controversy as to 
whether those kept in the state institutions of the insane or 
whether those kept in local institutions were best cared for and 
which had the largest percentage of recoveries and each side se- 
lected their advocates and appeared at that convention and 1 
remember in the report it showed that the local institutions had a 
larger percentage of recoveries than the state institutions and their 
reports were the most favorable of the two. That was about eight 
years ago. 

Q. Are you acquainted with the Erie County Home? 

A. Yes, sir; I have been connected with the board there, with 
the exception of three years, for the last fourteen years as their 
solicitor. 

Q. What has been your observation so far as the hospital at Erie 
is concerned, in comparison to the State institution? 

A. We have not a system that we can compare for this reason, 
we have only taken off a portion of the buildings to keep the insane 
in and they have kept what might be called the chronic cases and 
sent all their acute cases to Warren, so it would not be fair to draw 
any comparison '"n that respect. 
10 



146 

Q. What has been your observation so far as the work performed 
by the Board of Charities is concerned? 

A. I think it is due to the Board of Charities to say that the 
Board of Charities made up in this way until recently, there has 
been some changes recently made in the Board of Charities and 
new blood injected into it, has been composed of men that were so 
engrossed in business that they could not give it proper attention, 
or were composed of men retired from business and did not want to 
use physical exertion to do it and so far as the State Board of 
Charities has been concerned, outside of the Lunacy Commission, 
the work has been thrown on one man and no one man can do the 
duty assigned to him by law, I don't care how much endurance he 
has. It is his business to visit every institution that receives State 
aid, every institution that has insane in it, and besides the amount 
of clerical work and office work, and the State should do one of 
two things, they should give the 'State Board of Charities, under 
the direction of their general agent two, three or four expert men, 
who should travel and inspect the State institutions, examine their 
books, their system of accounts and their treatment of the inmates 
and pay them for it, or else establish a department where under one 
head or duplicate head give them power of inspection. A board 
so created, of course, could not do the work themselves and they 
would have to have an expert in doing; either you have to do it 
or your superintendents are absolutely worthless. So far as the 
inspection is concerned nine times out of ten they always know 
beforehand when some one will be present. We have in our city a 
member of the State Board of Charities for several years; he died 
recently and I don't think he ever visited one institution except 
one local hospital, except when Mr. Biddle would come up he drove 
out to the almshouse with him. 

Q. Mr. Biddle is the only salaried officer? 

A. Yes, sir; and this work cannot be done without you pay them 
for it. 

Q. What do you think with reference to the New York system of 
having a central board? 

A. Well, I am rather in favor of that, possibly they should be 
but you cannot hold men to a very close accountability in the per- 
formance of their duties while appointed as honorary members and 
expect them to perform their duties without any compensation and 
I believe they should be reasonably compensated for the work they 
do and then hold them to a reasonable accountability for the work 
they do and then you get good work and otherwise you do not. 

Mr. Snyder. Has any member of the committee any questions to 
ask? 

(No response.) 



147 

Mr. Snyder, chairman. Is there any gentleman present who has 
not yet been heard, who desires to be heard? 

Mr. Gould. I desire, as chairman of the directors of the poor, 
to extend an invitation to this committee to attend the next meet- 
ing of the directors of the poor and the State Board of Charities 
that will be held in Somerset, I think in the second week of October, 
when these matters will be largely discussed and would like them 
to ask any questions they see fit and it may be they can get some 
information there. My experience has been this, Mr. Chairman, that 
there is only about one man in a hundred who takes any interest 
in public charities only so long as he is connected officially with an 
institution and that his interest dies out the moment he leaves. 
Others become interested in the work and make a life work of it, 
and for that reason I am opposed, after long study and deliberation, 
to the system of electing officers to take charge of our charities and 
making it a political office. I believe the system that is in vogue 
in some parts of the State is a good one, where the court appoints 
a man who shows an interest in the work and continues him in that 
office and not rotate him out of it. 

Mr. Snyder. In behalf of the committee I desire to extend thanks 
for the kind invitation and the matter of attendance will be laid 
before the committee. 

On motion of Mr. McClain, seconded by Mr. Sproul, adjourned at 
4.30 P. M. to meet Wednesday morning at 10 o'clock A. M. 



Met Wednesday, May 7, 1902, at 10 o'clock A. M. 
Mr. Snyder, chairman. Dr. Orth, of the Pennsylvania State Lu- 
natic Hospital, of Harrisburg, Pa., being present, I call upon him. 

Dr. H. L. Orth testifies as follows: 

Examination conducted by Mr. Snyder, chairman. 

Q. How many inmates has your institution at this time? 
A. We have, I think, 894; capacity for 700. 

Q. How many males and how many females have you in your insti- 
tution ? 

A. Four hundred and forty-seven males and the balance females. 

Q. What has been the average cost, per capita, for maintenance? 

A. Three dollars and seventy-five cents; ever since I took charge 
of the hospital I expended the full limit. 

Q. How are the employes of the institution obtained, who does the 
hiring and discharging of them? 



148 

A. The superintendent does everything under his control. 

Q. Any system to find out the character of the employes? 
* A. Eequire a recommendation under all circumstances; they make 
written applications and give references and those references in- 
quired into. 

Q. What is the average proportion numerically of your attendants 
to the number of your inmates? 

A. About one to nine, or a trifle over nine. 

Q. What is the source of your water supply? 

A. We have a creek running through the grounds, the water 
sheds of which we control and that water is carefully filtered through 
a sand filter by which we extract about 97 or 98 per cent, of all 
bacteria life by actual count. 

Q. How are your buildings heated? 

A. By steam. 

Q. Direct radiation? 

A. Indirect and direct radiation. 

Q. How are they lighted? 

A. By electricity. 

Q. Are the wires properly protected? 

A. Yes, sir. 

Q. What protection have you in case of an outbreak of fire? 

A. We have no fire escapes except all the stairways are built in 
walls of 22-inch thickness and none of the patients are located above 
the second floor. I think it is the only hospital in the State ar- 
ranged that way. 

Q. What year were the buildings built, that is, the first one? 

A. In 1849; I believe the corner stone was laid in 1849 and fin- 
ished in 1851. 

Q. All your buildings were built many years ago? 

A. Yes, sir; except within two years we put up two buildings. 

Q. Are there any women managers of your institution? 

A. No, sir. 

Q. Would it be any advantage to have them? 

A. It would be very pleasant to have them but I don't see what 
advantage it would be. 

Q. How are your supplies obtained for the use of your hospital? 

A. Make annual contracts. By law we are compelled to adver- 
tise the first Monday of April and letting made thirty days subse- 
quently. It is competitive. 

Q. Have you some one to inspect and examine your supplies in 
order to ascertain whether they conform to the stipulations under 
which they were obtained? 

A. We have a very careful storekeeper and nothing passes through 



149 

liis hands unless they come up to the standard of bids; they must 
comply to that standard. 

Q. How many visits do the board of trustees make to your insti- 
tution as a body? 

A. They meet four times a year but we have an executive board 
who come out there at least monthly, sometimes more frequently 
than that, but regularly that often. I am in constant communica- 
tion with them. They live but a short distance from us and they 
come too often sometimes. 

Q. Do you think if the supplies for your institution were furnished 
from some central source, that it would be of any advantage, for in- 
stance some central source would supply all the State institutions? 

A. Buying in large quantities you can always buy cheaper; it 
might be some saving to the State. 

Q. You see no objections to that system? 

A. It depends on how it is conducted, conducted honestly I know 
of no objection. The great difficulty with contractors they all want 
to give us better than we specify at a reduced rate. 

Q. How many hours are your attendants, nurses and others on 
duty? 

A. From 6 o'clock in the morning until 7 o'clock at night, with 
two hours intermission. 

Q. How many private patients have you? 

A. I think twenty-five; we have not received any private patients 
since 1895. 

Q. What are the rates charged for private patients? 

A. They average about |3.85; I think it is $3.85. 

Q. What restrictions do you place on letters written by patients 
to persons outside? 

A. Letters to their immediate friends are sent without any super- 
vision. To outside parties they are not permitted to go as a rule. 

Q. If there is anything objectionable in them what is your prac- 
tice? 

A. Under those circumstances they are placed on file and sub- 
ject to the Committee on Lunacy and if approved by them they are 
sent to their friends. 

Q. There are no restrictions placed on letters written to county 
judges or their counsel? 

A. No, sir; I don't object to anything reasonable sent to them. 
Of course we don't want anything obscene sent to the county 
court. 

Q. How many times did the Committee on Lunacy visit your insti- 
tution last year? 



150 

A. I think last year three times; that has been due to the illness 
of the secretary. 

Q. And how often did the State Board of Charities? 

A. Once or twice a year. 

Q. Do they go through the different wards? 

A. Yes, sir. 

Q. Is there any other business they transact outside of that? 

A. They generally inspect our reports and our method of doing 
business. 

Q. Who usually visits your institution from the State Board of 
Charities, the secretary or whom? 

A. The secretary of the Board of Charities and one or two mem- 
bers of the Board. 

Q. Do you have any inmates in your institution of whom you or 
your medical faculty entertain any doubt as to their insanity? 

A. Where we do we report it to the Committee on Lunacy and the 
court. During last year we had three or four committed who were 
not insane and had great difficulty in getting them out of the hos- 
pital. 

Q. (By Mr. Hall.) How were they committed, by order of the court? 

A. By order of the court. 

Q. It was not a case where two physicians certified? 

A. In one case two physicians certified, in Berks county he as- 
saulted one of the attendants at the almshouse and it was less trou- 
ble to put him in the hospital than to jail. They were discharged 
in thirteen or fourteen days, as soon as we could get rid of them. 

Q. (By Mr. Snyder.) What other order have you besides the order 
of the court? 

A. On the certificate of two physicians and voluntary patients; 
they come in every thirty days. 

Q. And those sent through the directors of the poor? 

A. They are admitted on the certificate of two physicians. 

Q. Is the line of demarcation tightly drawn between the male 
and female inmates, as to social life? 

A. As far as possible we keep it under control. 

Q. Do you separate the acute cases from those of other forms of 
insanity? 

A. I am sorry to say that we cannot; we have not the facilities. 

Q. On the subject of book-keeping, is there a uniform system of 
book-keeping in your institution? 

A. We have our own system which has been in use for twenty 
years; it is very satisfactory and we account for every penny. 

Q. Who inspects that account? 

A. The accounts are inspected twice a year by some one sent by 



151 

the Auditor General, and we submit reports every three months and 
we cannot receive any money until our accounts are approved; that 
is one defect in the system, we have to spend the money before 
we get it. 

Q. Might not a conference of superintendents prescribe a system 
of uniform blanks which would imply, if it did not compel, a sub- 
stantial uniformity of methods in administering the affairs of all 
the hospitals? 

A. It would be very advantageous. 

Q. And once in three months for all superintendents to meet 
and consult in relation to matters connected with the care and 
maintenance of hospitals? 

A. I think to meet once in three months would be sufficient, other- 
wise it would take a great deal of time. 

Q. What provision have you in the case of an outbreak of any 
contagious or infectious disease? 

A. We have no protection except we have to isolate the people 
the best we can, we do that in the upper ward. We had three 
cases of measles within the last six months. 

Q. There is no epidemic with you now? 

A. No, sir. 

Q. What system of religious observance do you have in your in- 
stitution? 

A. We have none except we have prayers every evening at 5 
o'clock. 

Q. You don't have any services on Sunday? 

A. No, sir; we have no chapel in which to hold them. The Legis- 
lature compelled us to tear down our chapel seven years ago. It 
was on the fourth floor and they were afraid it would fall down; 
it was a regular fire trap and it was perfectly proper. The only 
criticism I have to make is that they don't give us another one. 

Q. What is the formula by which you transfer patients from your 
institution to others? 

A. By order of the Committee on Lunacy. 

Q. Any special blanks? 

A. There is a general form order of transfer; we advise the 
Committee on Lunacy and they issue the order of transfer. 

Q. Do you not believe that so far as it is possible the application 
of correct civil service principles for employment in the various 
hospitals would be beneficial? 

A. Very desirable. 

Q. Especially amongst the nurses? 

A. Nurses and officers both. 

Q. Can you make any suggestions with reference to what might 
be a proper means of preventing the increase of insanity? 



152 

A. The only means I know of would be castration; I don't know 
of any other. 

Mr. Snyder. Has any member of the committee any questions 
to ask? 

Q. (By Mr. Hall.) Do you think there is anything in the present 
condition of our life as compared with the conditions which existed, 
say fifty or a hundred years ago, as bearing on the subject of mental 
troubles ? 

A. I can recollect back fifty years and I would say that our life 
is more strenuous and more exciting at present and anything that 
breaks down the general system is liable to impair the nervous 
system and it generally causes mental troubles. 

Q. Do you think insanity is on the increase? 

A. Not practically. 

Q. Isn't it possible that persons confined in the asylums about 
fifty years ago were just considered a little queer? 

A. Perhaps we are more humane than we were fifty years ago. 

Q. (By Mr. Snyder.) The law in reference to the transfer of female 
patients has been observed, that is, to have female attendants with 
them? 

A. It is not always; where it is not observed I call the attention 
of the Committee on Lunacy, or the persons who have them there, 
or state the facts to the Committee on Lunacy. I do not like to act 
as informer but the facts are stated to them and they take it up. 

Q. Have you any suggestions or recommendations to make with 
regard to our present laws for the care and treatment of the insane 
which you consider of importance? 

A. I think they could be made more uniform and if there was 
sufficient room given to the officers of the hospital to take care of 
their patients I think there would be a decided improvement in 
the result. 

Q. (By Mr. Hall.) There is insufficient room in your hospital the 
same as others for the accommodation of your patients? 

A. We have the smallest and most contracted building in the 
State. We have a population of over 30 per cent, over our normal 
capacity and the place is dangerously crowded. 

Q. That militates against good results? 

A. Yes, sir; it certainly does. I have prepared a statement which 
includes a great many of the questions you have asked me which I 
will leave with you. 

Q. (By Mr. McClain.) Are you still occupying the old building? 

A. Yes, sir; we have two in a room. 

Q. How many patients have you in that building, in the old 
building? 



153 

A. About four hundred; three hundred and eighty to four hun- 
dred. 

Q. In the old building? 

A. Yes, sir. 

Q. How many on the third floor? 

A. None; I removed them from the third floor two years ago. I 
am devoting that to attendants now. 

Q. In which practice do you think the best possible results can 
be obtained: In having many patients in one large institution or 
having a number of institutions throughout the State and fewer 
patients in them? 

A. If properly classified I think one institution would be more 
satisfactory; you could run it more economically. 

Q. Apart from the question of economy what effect would it have 
on the patients, one large institution with a great many patients 
in it, or a number of institutions with a less number of patients in 
them? 

A. Within certain limits I would say that the larger number of 
patients in a large institution would be more beneficial. 

Q. (By Mr. Marshall.) Do you mean you would get better results? 

A. Yes, sir. 

Q. (By Mr. McOlain.) What do you suggest to be done with the 
criminals who are insane? 

A. I think the best plan would be to have a separate institution 
for them; I don't think it is human to keep them with the ordinary 
lunatics. 

Q. What do you think with reference to the present Board of 
Charities? 

A. I think their powers ought to be enlarged, if continued; they 
are merely advisory and have no control over institutions. 

Q. In your opinion, in establishing a State department, such as 
they have in use in New York, do you think it would work to better 
advantage than under our present system? 

A. I have not examined that law; it has only been passed recently 
and not gone into effect. 

Q. I think it has? 

A. I am not certain about it and I cannot give an opinion. It 
is but a very short time that it has gone into effect, if it has. 

Q. How often does the State Board of Charities visit you? 

A. I think last year they were there three or four times and the 
'State Committee on Lunacy was there two or three times. 

Q. Has their examination been superficial or thorough? 

A. Sometimes* superficial and sometimes thorough; it depends 
on the amount of confidence they have in the superintendent very 
frequently. 



154 

Q. (By Mr. Marshall.) Do you think it good policy to separate the 
acute chronic cases? 

A. Undoubtedly, if you have a separate building. 

Q. In a different institution, such as at Wernersville, I mean, 
could you procure better results? 

A. In a large institution there will always be a certain number 
of acute cases brought there and they could be treated in a separate 
building; they require more care, more nursing and more super- 
vision. 

Q. What proportion of acute cases have you in your institution 
now? 

A. Now, I don't think I have ten cases in the hospital that are 
curable. 

Q. (By Mr. Hall.) Isn't that an unusually small percentage? 

A. Yes, sir; it is an unusually small percentage, due to the fact 
that we are not receiving any private patients; they do not like to 
be committed as paupers except in case of necessity. 

Q. (By Mr. McClain.) In case of fire could the patients in the 
old building be removed at night with safety? 

A. My arrangements are such that I think they could be got out 
without any difficulty but as I have stated it is a regular fire trap 
and would burn up almost like powder. 

Q. The only thing to be done there would be to erect a new build- 
ing? 

A. Yes, sir; to tear it down; our flues are nothing but lath and 
plaster and not even lined with tin. I have been trying to do it for 
the last fifteen years. 

Q. The appropriation made by the last Legislature was not suffi- 
cient to erect a new building to take the place of the old building? 

A. It is only sufficient to accommodate about 110 or 115 patients. 
We have plans executed but the cost of material advanced so much 
that we could not comply with the architect's plans but we expect 
to commence about the first of July. That building holds about 300 
to 400 patients and we have an appropriation to build for the ac- 
commodation, I think, of 110 or 120 patients. We made application 
for $500,000 and they gave us but $110,000. 

Q. (By Mr. Hall.) What are the wages you pay the attendants 
there? 

A. On the male side we pay from $14 to $25 per month, according 
to the time of service; on the female side we pay from $11 to $18. 

Q. Do the female attendants perform the same work that is per- 
formed by the male attendants? 

A. Practically the same; the heavier work is done by the male 
attendants, cleaning carpets and such things. 



._ 



155 

Q. As far as attending the insane themselves are concerned their 
duties are the same as in the other department? 

A. Exactly the same. 

Q. And the hours of labor about thirteen? 

A. Yes, sir. 

Q. Do you consider that not too long? 

A. The labor is light but it is very confining. 

Q. Do you have trouble in keeping help there? 

A. Satisfactory help, yes. 

Q. They go away? 

A. Yes, sir. 

Q. The hours and the character of the work are not such as to 
make it a desirable position? 

A. No, sir. 

Q. For a man or woman to settle down in that position? 

A. Yes, sir; we retain the female help longer than we do the 
male help. 

Q. You said awhile ago that you make your contracts annually. 
Do you think it is a good plan to do so? 

A. It is mandatory. 

Q. It is under the act of Assembly? 

A. Yes, sir; under the act of 1845. 

Q. For example, contracting for a delivery of beef at this time, 
do you think that is advisable? 

A. We made our contracts yesterday for ten cents a pound for 
the year around; that is a slight advance over last year; last year it 
was 7,85. I think it increases our expenditures about ten thousand 
over the prices of the supplies last year. 

Q. From your experience do you think it is a good plan for pa- 
tients to be committed to an asylum, without a judicial inquiry, 
simply on the certificates of two physicians? 

A. Under certain circumstances it would be a great hardship to 
wait on judicial proceedings. At present you cannot commit a 
patient to a hospital under four or five days by the course of judicial 
procedure and very frequently a patient wants to be committed 
at once and I think as a rule physicians are honest, sometimes they 
lack judgment and any mistakes are mistakes of judgment and I 
find more mistakes of judgment made by the courts than are made 
by physicians in the last ten years. 

Q. That is your experience? 

A. Yes, sir. 

Q. Do you believe there ought to be separate institution *or the 
criminal insane? 



156 

A. Yes, sir; I should say not for the criminal insane but for the 
convict insane, because very frequently an insane man commits 
a criminal act. 

Q. Do you think there should be a place for the convict insane? 

A. Yes, sir. 

Q. Do you know how many there are in the State? 

A. I don't think there are over 125 or 150. By reference to the 
report of the Committee on Lunacy I can tell you in two minutes. 

Q. Do you think there ought to be a separate place for the acute 
cases, separate department for the acute insane? 

A. Yes, sir; I am building one myself at present. We have none, 
we have been so crowded that I doubt if we will be able to use it 
on account of the overcrowded condition of the hospital. 

Q. (By Mr. Bliss.) Do you think it would be wise to have one 
hospital in the State for the acute cases? 

A. The distance is too great to carry them from all sections of 
the State to one hospital; I think there ought to be a separate build- 
ing at* each hospital for acute cases. 

Q. (By Mr. Hall.) I believe you said there were ten acute cases 
in your hospital? 

A. Ten curable cases; there is a difference between acute and 
curable. 

Q. (By Mr. McClain.) What did you say was the cost for mainte- 
nance? 

A. Three dollar's and seventy-five cents; $1.75 paid by the county 
and $2.00 paid by the State. I offer the following prepared state- 
ment, in addition to my testimony: 

With the advent of Miss Dorothea L. Dix into Pennsylvania the 
corner stone of this hospital was laid and the humane system of our 
State care for the insane was inaugurated; this was continued for 
several decades. Thousand upon thousands of dollars were appro- 
priated and expended for their care and in the erection of three 
State and two semi-State hospitals, and one asylum, seemingly 
adequate provision for all; but want of careful enumeration of these 
unfortunates and lack of foresight in estimating their increase, due 
to the rapid growth of our population from natural causes and 
from immigration, frequently of the pauper and degenerate classes 
of foreign countries, due systematic provision for their care and 
maintenance has not kept pace with their increase. In addition 
to this, the mandatory act of '89, committing all lunatics to State 
hospitals, who could not be properly cared for in their own county 
homes, and the gradual education of the community at large, that 
their friends could be more intelligently treated and at reduced 
expense, in a State hospital than in their own homes, has so pop- 



157 

ulated our State institutions that they are a menace to their in- 
mates. To relieve this overcrowding, the Legislature in their wis- 
dom, at the suggestion of the Board of State Charities, authorized 
in '95 (what had been abandoned in ? 89), namely: The care and 
maintenance of the insane in county homes, with however, the addi- 
tional precaution of State inspection. This retrogration in oppo- 
sition to the accumulated experience of years does not seem to be 
justified by any reasonable argument; the theory of reduced cost, 
because of reduced expenditure, is so fallacious as to be untenable, 
while the assumption that they will receive the same care and 
treatment that is given to them in large hospitals, is so incorrect 
as to approach the ridiculous. The fact that large numbers of 
people can be taken care of at less cost per capita than small, other 
things being equal, is so self evident as not to require argument. 
All insane require supervision; the same amount of supervision must 
be given to two harmless insane as to twenty, and the only diminu- 
tion in cost will be in food and clothing. To keep the expense within 
explainable limits, curtailment will be made in the number of at- 
tendants, in bedding and in the protection that their mental state 
demands; demands, I repeat, because a lunatic is not in a proper 
sense a pauper; because he is enfeebled by disease and has become 
a menace to the community, he should not be treated as a pauper, 
to be taken care of at the least expense capable of sustaining life, 
but should be protected in a manner creditable to the State. This 
brings me to the object of my inquiry, how best to take care of the 
insane. It is a difficult question to answer; to suggest a chimerical 
idea is easy but to submit to you a practical plan based upon 
experience is, as I have said, difficult. 

The superintendents of the State hospitals, because of the over 
crowding for the last fifteen years, have not been able to fairly 
carry out the approved methods of treatment; their whole effort 
has been to care for and maintain their inmates. My own hos- 
pital (I speak relatively by way of distinction) has been a huge pen 
where the insane are herded; the other hospitals are in a like condi- 
tion. You have been appealed to time and time again but the 
appeals have been unheeded until the condition of insane in the 
State is so disgraceful that almost any change will be an improve- 
ment. The acts of '69 and '83 creating the Board of Charities and 
Committee of Lunacy, undoubtedly were beneficial by requiring in- 
spections, systematic records and reports, but they have no control 
over the institutions; they can only act in an advisory manner; their 
powers should be enlarged. 

The wages of attendants should be uniform. The methods of 
keeping accounts should be the same in all hospitals; their expendi- 



158 

tures should of course be limited to a definite per capita. The 
terms of office of all officials should be uniform; they should be 
appointed only after competitive examinations and the appoint- 
ments should be for life or during satisfactory service; satisfactory 
as indicated by yearly results, said results determined by reports 
based upon careful inspections. Their salaries should be graded, 
promotions should be made for time of service and merit. You 
would thus have a force of young men in training from which could 
be drafted the superior officers. 

To relieve the over crowding, various ways present themselves, 
but they are all more or less expensive. The epileptic and criminal 
insane should be cared for in hospitals or farms designed for that 
purpose, while the surplus population in the hospitals would most 
economically be provided for by increasing the capacity of the 
present institutions. The steam and electrical and laundry plants 
and the water supply, with their operating departments are at 
hand, the executive departments are fully equipped, the hospitals 
are supplied with officers who can superintend construction and 
all that will be required is the erection of additional wards. A 
comparatively small amount will accomplish this result. 

It seems too self evident to suggest to your honorable body but 
it might be attributed to ignorance if I fail to mention, that every 
hospital plant should be equipped with a pathological, electrical and 
hydrotherapeutic departments, with necessary operating rooms; 
with carpenters, machine, shoe and upholstering departments and 
sewing rooms in which many patients can be usefully employed; 
with a chapel and amusement hall for the diversion of the inmates, 
play grounds, etc., but these are mere A. B. C. details that all 
the hospitals have been striving to secure; some have obtained, 
others, myself included, have been compelled to tear them away on 
account of their worn out and dangerous condition. 

The framers of the act providing for the erection of this hospital, 
with wise foresight, anticipated our present troubles by enacting, 
first, that the number of patients admitted from the various coun- 
ties should be proportioned to the population and that acute cases 
should have preference over the chronic insane. In '92, owing to 
the deplorable condition of the hospital, my board of trustees on my 
recommendation, availed themselves of this clause and limited the 
capacity of the house to eight hundred. As ventilation, etc., of 
the hospital was improved the limit was raised to nine hundred, 
though the cubic air capacity was calculated and built for but 
seven hundred; to crowd beyond this point was a menace to the 
inmates and we did not feel justified in receiving patients above 
this limit. The diminution of fresh air and the propinquity due 
to over crowding not only created irritabilitv and restlessness but 



159 

diminished their vitality to such an extent that their inherent 
resisting powers were impaired and they easily succeeded to epi- 
demic influences. It thus seemed more humane that a few should 
be subjected to temporary discomfort than that the 900 should be 
exposed to danger; at no time was any applicant compelled to wait 
for admission over fourteen days and never with any special detri- 
ment to themselves. That our work has been doubled and our 
anxieties increased goes without saying and our great surprise 
is that we have been protected from an alarming death rate and in 
any way secured favorable results. 

I have endeavored to advert, as succinctly as possible and with- 
out tiring you with elaborate details, to the facts that have forced 
themselves upon our attention in the last two decades and trust 
that they may be of some assistance (by suggestion) in enabling you 
to mature some practical plan that may ameliorate the condition 
of the poor unfortunates in our over crowded hospitals. 



Dr. Mary M. Wolfe resumes and testifies as follows: 
Examination conducted by Mr. Snyder, chairman. 

Q. How long have you been in charge of the women's department 
at the Norristown hospital? 

A. I took charge on the 1st of February, 1901; a little over a year 
ago. 

Q. How many visits have you had by any member of the Board of 
Charities in your department? 

A. Well, no member of the Board of Charities has been into the 
wards, but they have been to see me. 

Q. But have not been in the wards? 

A. No, sir. 

Q. Since February, 1901, has the secretary, or any members of the 
Board of Charities been there? 

A. Dr. Wetherill has been to see me two or three times but the 
members of the Board of Public Charities have not been in the 
wards. i 

Q. Dr. Wetherill is connected with the Committee on Lunacy? 

A. Yes, sir. 

Q. The secretary of the State Board of Charities is the person you 
saw outside of the ward? 

A. You mean Mr. Biddle? 

Q. Yes, ma'am. 



160 

A. Mr. Biddle has not been to see me; lie was in the trustee's 
room one day and I had some conversation with him there, but aside 
from that he has not visited me. 

Q. He has not visited your department? 

A. No, sir. 

Q. (By Mr. Hall.) You said there had been some members of the 
Bqard of Charities at the hospital? 

A. Yes, sir. 

Q. They were members of the Committee on Lunacy? 

A. Yes, sir; Dr. Wetherill has been there a number of times. 

Q. He is the secretary; aside from him has any one visited you? 

A. Dr. McCloud was there a few weeks ago and aside from Dr. 
Wetherill and Dr. McCloud none of the Board have been there. 

Q. The attendants in your department are all women? 

A. Yes, sir; both physicians and attendants. 

Q. Are the women attendants in your department paid as much 
as the men in the male department? 

A. They are not. 

Q. How much less? 

A. That is more than I can tell; I never bothered about how much 
the men were paid but I can tell how much our women are paid 
and Dr. Richardson can inform you about the men. The highest 
salary for nurses is $30 for the nurse who has charge of all the 
night nurses. Our hospital is a little different from the others. 
This night patrol who gets thirty dollars per month has full charge; 
in going through all those sections she gives the medicine and looks 
after the patients and all that; and then our day nurses who have 
charge of individual sections get $25 a month; the average run 
from $16 to $18. When a nurse first comes there she gets $14 and 
then after she has been there a little while she is raised to $16 and 
then $18, but she never goes above $18 unless she has served there 
some time and has some special higher position. 

Q. There being no men in your department, all the work falls 
upon the women? 

A. We have three men who we call extra; they bring our clothes 
from the laundry to the assorting room and carry them up into the 
different wards and do anything like that in heavy carrying, remove 
all the trunks and things like that. These are the only employes 
who are men in the women department. 

Q. So far as the attendants on the insane is concerned the attend- 
ants in your department do exactly the same work as the men in 
the other department? 

A. Yes, sir. 

Q. Yet they are paid less? 



161 

A. Yes, sir. 

Q. Do you think that is right? 

A. Well, that depends on the way you 100k at it; if you look at 
it from the standpoint that you can get women, at what amount 
you can get them for and what amount you can get men for, it is 
a fair thing. If you pay people according to the work done it is not 
right, but then in this world we all do not get that. 

Q. That is, an advantage is taken of the one class of attendants 
because of their sex? 

A. You take those women and the kind of women we get, they 
are the women who would otherwise be in kitchens or factories, or 
something of that kind and they could not in any case demand any 
more pay than they get from us. But, on the other hand, it is 
different with men who can take positions that would pay them more 
money and an advantage is taken of that fact and women get less 
money. 

Dr. D. D. Richardson resumes and testifies as follows: 

Examination continued by Mr. Hall. 

Q. What are the wages paid the attendants in your department? 

A. From $14 to $35; we have one attendant on the night patrol 
who receives $35, recently increased from $30 to that amount. When 
a man comes on at first he comes on at $14 a month and if accept- 
able he is increased to $18 the next month, and if he continues to 
be a good man we give him $20 in six months. The highest wages 
are given to the men in the graduating school. We make considera- 
tion for those men by giving them the best positions in the hos- 
pital. Our course is two years and they must study two years be- 
fore they can graduate. 

Q. If a man studies two years and works, how many hours does 
he work a day? 

A. If not off at night he works until 9 o'clock and the fourth 
night he is off from 7 to 10 o'clock. He gets up at 5 o'clock and 
goes to work at twenty minutes past five. The service is long and 
it is not right. 

Q. What does a man earn who does not graduate? 

A. We start him in at $14 a month and then at $18 and then 
at $20. 

Q. And those who graduate, how much do you pay them? 

A. The man who graduates gets the highest price that is paid; 
there is a tendency to give every man $25 after he is graduated. 

Q. Do you think that is enough? 

A. No, sir; I don't. I think attendants, particularly women, are 
poorly paid in hospitals for the insane and there is no earthly reason 

11 



162 

why a woman should not have as much as a man where they do 
the same amount of work, not the least bit of it. I have an experi- 
ence of forty-six years as a superintendent in connection with insane 
people and as a student of insanity, and the longer I live and the 
more I see I am firmly convinced that women are worth just as 
much as the men. They have more work in a certain line than the 
men have to do and I think it is contemptible to take advantage of 
women because she is a woman. 

Q. (By Mr. Snyder.) The salaries paid at your institution are fully 
as large as at any other institution, in both the male and female 
departments? 

A. I don't know about the female department but in the male de- 
partment I think they are. 

Q. How many years have you been connected with the Norristown 
hospital? 

A. Going on nine years. 

Q. How many visits have you had from the Board of Charities 
in your department? 

A. I have not kept account but we have frequent visits from 
Dr. Wetherill and from Dr. McCloud, and one or two visits from 
Mr. Biddle, who goes all over the department. 

Q. During the last year has Mr. Biddle been in your depart- 
ment? 

A. Yes, sir; Mr. Biddle and Dr. Wetherill and Dr. McCloud fre- 
quently. We have a very large hospital and it necessary to call 
on them more frequently than some others do. 

Q. (By Mr. Marshall.) Do the attendants sleep in the same wards 
where they work during the day? 

A. Yes, sir; and it is a shame that they must occupy the same 
quarters. 

Q. Do you think it is right for a man to attend the insane all day 
and then be housed with them during the night? 

A. No, sir; we showed that in asking the Legislature to give 
us an appropriation for the erection of a Nurse's Home. We think 
after they have served a certain length of time among the patients 
they ought to be able to get out of it and get rested away from the 
scene of their work. 



Dr. H. L. Orth recalled and testifies as follows: 
Examination conducted by Mr. Snyder, chairman. 

Q. Do the attendants sleep in with the insane? 

A. A majority of the attendants sleep in different dormitories, 



1G3 

which has been brought about by the removal of the patients from 
I he third and fourth stories and placing the attendants there. 



Mr. Snyder, chairman. I now call upon Mr. William M. Geary, 
superintendent of the Bureau of Charities, in the city of Philadel- 
phia. 

Mr. William M. Geary testifies as follows: 

Q. You are connected with the Philadelphia Bureau of Charities, 
which includes the Blockley Almshouse? 

A. Yes, sir; as superintendent. 

Q. How many inmates have you in your institution? 

A. We had on the 24th of April, 1,444; I take that date because it 
varies; it varies every day with us, and we had. on that date 671 
men and 773 women. Seventy of the men epileptic, and 65 women 
epileptic ; and when they become entirely insane they are put in the 
insane departments. 

Q. You have no separate building for the confinement of the 
epileptics alone? 

A. No, sir; we have not. 

Q. What is the average proportion of attendants, numerically, 
to the number of inmates? 

A. It varies according to the number of acute patients. We have 
65 male attendants and 65 female attendants, a total of 130 average 
attendants; that is a little over one to ten. We have one ward where 
we have eleven attendants to forty-two patients, and another ward 
where there was one attendant and ninety patients; it goes according 
to the condition of the patient, some requiring more attention than 
others. 

Q. What provision have you in the case of an outbreak of fire? 

A. W T e have, in the first place, the Philadelphia Fire Department; 
we have four trained firemen in our institution, two at night and 
two in the daytime; they have the entire care of the institution as 
far as protection against fire is concerned. They make daily ex- 
aminations and inspection through the buildings and report daily; 
and if there is anything inflammable or anything that needs atten- 
tion they report it to me and it is remedied. In addition, we have 
a chemical fire engine, and in the office and other departments we 
have one or more fire extinguishers. We also have through the 
various wards standpipes to which is attached hose which reaches 
to every quarter of the buildings; and we have in the departments of 
the insane building, besides, enclosed fire escapes built of stone 



164 

brick and iron on which six men can walk abreast up and down. 

Q. The buildings are two stories high? 

A. No, sir; some parts are two stories high and others are three 
stories high. By the authority and advice of the State Board of 
Charities and the Bureau of Correction and Charities of the city 
of Philadelphia three stories were permitted to be put on some of 
the buildings and each one of every story has that fire escape in 
connection with the buildings, constructed of stone, brick and iron, 
rough cast. 

Q. How are your buildings lighted? 

A. By gas and electricity; the electricity we create on our own 
grounds; we have an electric light plant on our own grounds and 
from that is furnished the electric light. 

Q. You have no private patients? 

A. We have patients that pay. The patients who are admitted 
are supposed to be patients who are of the indigent poor class, but 
we frequently find that some who are brought there with that under- 
standing either have estates, or their relatives, and in those cases 
Ave ask some conpensation, but not as private patients. 

Q. Do you make any difference in the treatment of them? 

A. No, sir; they are with the other patients and there is no dis- 
tinction as to the treatment. 

Q. How frequently does the Committee on Lunacy and the Board 
of Charities visit your institution? 

A. The members of the Committee on Lunacy and also the mem- 
bers of the Board of Charities visit us quite frequently; they come 
to us at irregular times, unannounced. Our office is open and there 
is no hindrance; of course they are Philadelphia members. I do not 
know of any outside members being there. 

Q. I had reference to the State members? 

A. Of course those who visit are members of the State Board but 
they are residents of Philadelphia. 

Q. What kind of inspection do they make? 

A. I don't know; they usually enter the premises without my 
knowledge and see me when they go out. They go through the 
wards and we have had them come there as late as eleven o'clock 
at night to see, I suppose, the condition of the institution. 

Q. How are the patients admitted to your institution? 

A. Admitted first on the certificate of two reputable physicians. 
In some cases they are brought to us by the police authorities 
who take them up on the street or bring them from the station 
houses and then they are brought there by the police surgeon, who 
sends us a statement stating that he examined the patients and they 
require hospital treatment: and the third class are those that are 



165 

admitted who come there as mild epileptic cases and if their dis- 
ease results in insanity they are not put into the insane wards 
without first going into what we call the detention or observation 
ward; and I am glad to say that many of those who are in that 
detention ward never go to the department for the insane. 

Q. What provision have you in the case of an outbreak of a con- 
tagious or infectious disease? 

A. Isolation on the ground connected with the building, but we 
believe in preventing an epidemic, if it is at all possible, and we 
flatter ourselves in the fact that when there was an epidemic of 
small-pox broke out in this city sometime ago that there was but 
a single case, outside of twelve thousand cases, in that building that 
developed small-pox. 

Q. A good many patients of Philadelphia are taken to the Norris- 
town Insane Asylum? 

A. Yes, sir; twelve hundred on an estimate are there now. 

Q. They are not admitted except by order of the court? 

A. Yes, sir; the court makes the order. 

Q. What is the capacity of your present institution? 

A. The maximum capacity is, according to air space, between 
975 and 1,000, so we have over 50 per cent, over our capacity. 

Q. Therefore you would not be able to take care of those at Nor- 
ristown at the present time? 

A. No, sir; not at the present, but I hope in the near future that 
Philadelphia will be able to do something better. 

Q. What is your method for the discharge of a patient from your 
institution? 

A. It is first passed upon by the physician in charge and if by 
proper examination he determines from the condition of the pa- 
tient, that is, his mental condition as well as physical, that he 
is in such condition as to enable him to pronounce the man cured 
or improved he reports it to me and I consent to the discharge and 
issue the discharge. No person is admitted to the institution or 
discharged from it without the consent of the superintendent. 
Under the direction of the Board of Charities this morning I 
issued the orders for the discharge of four patients whom I believed 
were cured. Many times in the case of relatives they will make ap- 
plication to be taken out for thirty days on parole to see whether 
they are cured, and if they do not have any return of their delusion, 
hallucination or whatever it may be, they will stay out; and then 
there are some cases wher they would like to have the parole ex- 
tended longer and under the law it is continued for thirty days 
longer, but the law does not allow it for a longer period than ninety 
dtays. 

Q. How many physicians have you in your institution? 

A. There is one chief resident physician and two assistant female 



166 

physicians, one assistant male physician, on the men's side, two 
additional physicians known as internes, and on the women side 
there are two female internes; and then we have what we term a 
neurologist: and this comprises the sole star! for the hospital for the 
insane. 

Q. What system of religions observance do you have? 

A. There are four different chapels in the institution but they 
are nor distinctly in the department for the insane. In the depart- 
ment for the insane we have regularly every Sunday a service by 
some minister of some church, some denomination, and at this ser- 
vice they assemble, the women on the one side and the men on 
the other side, and there the services are conducted. However, they 
are not conducted in the usual form of church services but more 
in the line of a i-oncert. more of singing than anything else, be- 
cause a man without reason has to be reached by some other way 
than by direct methods. During the w t ek we also have concerts 
for the entertainment of the patients. 

Q. You have amusements of different kinds? 

A. Yes. sir. 

Q. Do you not believe thai, so far as it is possible, the applica- 
tion of correct civil service principles for employment in the various 
hospitals would be beneficial? 

A. Among certain classes of officers, but among attendants I do 
not think it amounts to that much (snaj [ ing Lis fingei . "The most 
smiling face sometimes kid^s the sharpest tongue.*' and that is my 
opinion with attendants among insane patients. 

Q. How are the attendants appointed: who appoints the attend- 
ants at the Biockley institution? 

A. They are appointed by civil service rules under the Bullitt 
Charter of the City of Philadelphia, and every employe must go 
through a civil service examination that is held, as requested, by 
the various heads of departments. There was one held quite re- 
cently, it was held yesterday a week ago. and they furnished an 
eligible list on which the names are sent to the dirferent depart- 
ments. They send that list to me and I select from that list be- 
ginning at one end and making my selection and if a man appears 
competent for the work for which I select him he is retained: if he 
is cruel, intemperate, dirty or does not in any way meet the reqv 
ments of our institution he is not retained, nevertheless his civil 
service examination was of the best. 

Q. He is on trial? 

A. Yes. sir. 

Q. Have you any suggestion- : i ^commendations to make con- 
cerning the present law? providing for the admission of the insane 
in the hospital? 



167 

A. In the first place, I would suggest that the las.c be amended 
and made more rigid for the admission of patients to insane asylums. 
I am fully convinced in my own mind, however, without positive 
proof anywhere, that people do go into insane asylums that could 
be cured in other places. 

There are other suggestions that I think of, if you will permit me 
to make, in connection with these remarks: I might say that this 
institution is conducted a little different from other institutions; 
we have a combination of bureaus, we have the almshouse, the hos- 
pital general and insane asylum. I think some remedies can be 
made by law which will benefit the country in general. If I were 
to make the laws of Pennsylvania, as I feel now, I would make each 
and every county support its own insane, at least its own acute, 
even the chronic. For instance, a very good illustration occurred 
this morning. The friends of four patients came there this morn- 
ing who had come yesterday to see about the condition of the 
patients; the physician in charge gave it to them and he said: 
"I am perfectly satisfied that these people can be taken care of 
outside just as well as here' and perhaps better, because they will 
get more pure air and I don't think they will have a recurrence of 
the mania." Those patients were from Philadelphia and located, 
in consequence of that, near our institution; had their friends been 
from some other part of the State they would not likely have seen 
these patients and they would be in and not out. I dare say 
that it is the opinion of the attending physicians, the nurses and 
superintendent that if these friends have an opportunity to come 
and see the patients in whom they have an interest they will pay 
better attention to them. Again: The county authorities should 
provide for the maintenance of their own insane for the reason that 
they will insist that proper care and treatment is given the patients 
and it wiil result in reducing the expenditures to a very large 
extent. Again : I think the State of Pennsylvania should take the 
epileptics in charge and have a home or homes erected for epileptics 
alone because they are proper patients to put in a hospital by 
themselves and ought not to be in an insane asylum. We have in 
our institution to-day probably 235 epileptics; we have 11 idiots who 
are perfect idiots and they are under the age of fourteen. We have 
no other place to put those patients but in a room and a little yard 
but they should go somewhere else. We have no other way to do 
there. 

Another thing: The State of Pennsylvania has chartered and 
to-day there are two institutions in Pennsylvania for the training 
of feeble-minded children. It originally issued to Dr. Carter, of 
Chestnut Hill, for the establishing of a training school for feeble- 



168 

minded children; they get excellent training there; I know that 
from having one hundred and sixty children down there and some of 
them made excellent improvement but the tendency is to let those 
children remain there. I found there last year one of our children 
forty-one years old, a pretty old child. I found thirty-two at the 
age of twenty-five years; they were being employed there and were 
practically self supporting. I recall this, that one of those chil- 
dren is a self supporting baker and gets nine dollars a week as a 
journeyman baker in the city. One as a laundryman took the place 
of a woman that we paid $18 a month. There ought to be a home 
where there is some restraint to get to and where the idiots could 
go to. There is another thing, in connection with insanity about 
which 1 desire to say a word and which is of greater importance 
than all the rest and that is to get at the cause of insanity; and in 
my opinion it is in the jurisdiction of your committee to take that 
matter up and in order to do it I think you should make the marriage 
laws more rigid and more stringent. Sixty per cent, of the patients 
in the Philadelphia hospital, across the Schuylkill river, are tainted 
with insane blood, ten per cent, by alcoholism, leaving about thirty 
per cent, for all the other causes, epileptics and all others. Now 
a fair sample of that and that which called my attention first to the 
fact was a case in our institution like this, I will call him Mr. A~ 
for identification : There was in our institution a young man twenty- 
two years of age who was an epileptic but not a serious case, he was 
practically self supporting and we used him in a clerical way and 
around the dining rooms but he had to be somewhat under restraint. 
We had in the woman's ward a young lady who we will call Miss B., 
she was also an epileptic as well as able to work and go about and 
earn her keeping with us; she cost the city nothing; she kept the 
rooms clean and did such other work that she was able to do; she 
was not quite eighteen. These two young people passed each other 
in the hall at times in their respective work; they were not permitted 
to mingle with each other but were compelled to pass each other 
in their work in the various things they had to do; in so doing 
they got confident and formed what I call a passionate feeling. 
Our young man twenty-two years of age, not being dangerous, asked 
for his discharge; of course it was granted. One of his friends came 
and took him away and in less than a week my attention was called 
to a marriage license being issued to Mr. A. to marry Miss B., and 
I called on the clerk of the orphans' court and he showed me that 
the young man had complied with every requirement of the law 
and he had nothing to do but to issue the license. Of course I 
was considerably worried over that. I knew what a marriage of 
that character would result in as we have so many examples in 



169 

our institution and the only thing I could do, having found out 
that the young man made oath that his bride to be was of age, was 
to scare him and threaten to prosecute him for perjury. In this I 
succeeded and obtained the marriage license and thereby prevented 
the marriage. We have three sisters in the Philadelphia hospital, 
each one of whom is the mother of a large family of children and 
the whole family is tainted, and I hold that if you remove the cause 
you generally have no effect afterwards. 

Q. What do you suggest? 

A. I would suggest that more rigid marriage laws be enacted 
and if your committee will permit me I would like to put the sug 
gestions I have in writing. 

Q. We will be very glad to have you do so and place in the hands 
of the secretary. 

A. Of course my experience does not go back as far as some 
others. However, I have made a deep study of it and I have come 
to the conclusion that the first thing is to find the cause and if 
you find the cause you can possibly treat it with better success and 
as a result have less insane people. 

Q. (By Mr. Bliss.) Do you keep a record of the nationality of 
your patients? 

A. Yes, sir. 

Q. How large a proportion of your insane are foreign born, or 
children of foreign born parents? 

A. I cannot answer that without my record. I will furnish you 
with our annual report which gives the nativity, the age and every- 
thing connected with the patient. I will take great pleasure in 
giving your secretary the annual report as soon as it comes out of 
the hands of the printer. 

Q. (By Mr. Marshall.) Doctor, what percentage of cures do you 
have among the patients of your institution? 

A. I am not a doctor, I am merely a layman. That I can- 
not give you without my record. They all say that their 
institution compares favorably with the other institutions and 
I am very free to say also that our institution will compare favor- 
ably with any other institution in the number of cured cases. 

Q. Do you think it would be advisable to have hospitals estab- 
lished in the rural counties? 

A. By legislative enactment you have power to regulate that 
and I would suggest that where the population of a county is small 
make a certain number of counties a district and I would make a 
department of charities in the State of Pennsylvania and I would 
district Pennsylvania into charity districts just the same as judi- 
cial districts are apportioned among the counties of the State, and 
over each of those districts I would place a man and pay him for 



170 

his services. Your State Board of Charities and the Committee 
on Lunacy, outside of the officers, do not receive any compensation 
and in this age very little is being done without some compensation. 
Notwithstanding the care taken by the county I would absolutely 
have it under the supervision of the State. 

Q. (By Mr. Bliss.) Have you any objection to submitting your 
views on that subject in writing? 

A. Not at all and I shall be glad to put in that shape. I should 
have had a written statement at this time but I have been ailing 
since March and four weeks ago I lost my wife so that I have not 
been able to prepare a statement such as I would have been pleased 
to submit to the committee. 

Q. (By Mr. Hall.) Do you believe there is anything more by reason 
of city life than in rural life that causes insanity? 

A. Yes, sir; I do. There is more jealousy, more hate and more 
strain in city life than in the country; nature tempers us all and I 
think if you go to the corner of Market and 49th street, where one 
of the most prominent asylums is located, they will tell you that 
a large per cent, of their patients are from cities and they will also 
tell you they are from the city for certain causes. I don't know 
what to call it: Passions, jealousies, hate. Then you get them 
closer together and that no doubt causes more trouble. My sugges- 
tion, that the laws be revised as far as getting into institutions is 
concerned, I think is one of great importance. 

Q. Have you, in your experience, any knowledge of persons being 
committed to the insane asylum who are really not insane? 

A. 1 think we turn out fifty-five per cent, in our detention ward 
that never go in insane wards. They have come in on a certificate 
signed by two reputable physicians, physicians who were honest 
and signed them conscientiously and believed what they did was 
proper, but when these people were taken away from their surround- 
ings where they had been, probably under difficulties of family 
trouble, and taken away from there and put under restraint and 
g r ot quieted down and treated physically, in a few weeks they would 
be turned out on the highway and go away all right, although at 
the time they were brought there it was thought, and honestly 
thought no doubt by the physicians who certified, that they should 
be placed in the asylum. 

Q. What would have been the result if they had been put into 
a State asylum, many miles away from home? 

A. I think it would be worse because they would have been 
placed in insane wards at once and the stigma of insanity would 
have been upon them. As I have stated we have detention and ob- 
servation wards and when a patient comes to us, it does not make 



171 

any difference how prominent a physician may be who certifies his 
case to us, he goes into our detention ward, the males in the male 
ward and females in the female wards, and the neurologists who are 
on our staff look after them and the resident physicians are con- 
tinually watching them and there they soon learn and determine 
what condition of mind they are in and what should be done with 
them. If the physicians, or neurologists, think they are improved 
or should not be put into the insane wards they are put in such 
places as they think right and proper for the best interest of the 
patient. 

Q. They are first treated as invalids? 

A. Yes, sir; they go into the Philadelphia hospital and if found 
insane they are transferred. They do not go there until the cer- 
tificate is signed by the physician of the bureau. 

Q. Don't you think if they were put directly into the wards with 
people who are insane it would have a very bad effect upon them? 

A. Yes, sir; I certainly do. That is why we have our detention 
and observation wards; these wards are in existence for that pur- 
pose and to avoid the occurrence of such a thing that might be 
detrimental to the interest of the patient. We find some persons 
that if you would put them in there sane they would come out insane 
if you kept them there awhile. 

Q. Do you think any person should be put into an insane asylum 
on the certificate of two physicians without a judicial inquiry? 

A. A lawyer is as apt to err as a doctor. 

Q. But it is taking away a man's liberty; do you think his liberty 
should be taken from him without judicial process and be determined 
before the court? 

A. Yes, sir; in certain cases. In suicidal or homicidal cases it 
is very necessary to act promptly sometimes and you cannot wait 
until there has been judicial inquiry and a decision rendered by 
the court, but in ordinary cases I don't know but what judicial 
proceedings should take place and not let one or two physicians 
decide whether I am insane. 

Q. You say that 55 per cent, of those who go into the detention or 
observation wards are not insane? 

A. Yes, sir. 

Q. Suppose on the certificate of two physicians those people had 
been put directly into your insane wards, do you think that 55 per 
cent, would go out sane? 

A. No, sir; not 55 per cent. Of those we got a great many pa- 
tients from the police department. You frequently read in th# 
newspapers about people being picked up, on the streets, having 
a mania for something; they are sent to us by letter from the chief 



172 

surgeon, or district surgeon, stating that this person is demented 
or has a mania and he thinks he should be placed in the hospital. 
That necessarily does not come to us under the certificate of two 
physicians and we take into consideration when a man. who is a 
reputable man and a man of experience states that he believes that 
a party should be placed there, that we should accept it and act 
upon it. and we also get alcoholic cases in that way and they are 
included in that 55 per cent. Of course if a man has an ordinary 
disease he does not come there but if he gets a little wild he comes 
there. 

I will furnish you with my written statement of my suggestions. 
Your secretary wrote me and asked me for some photographs. We 
have none distinctly of our insane department but I hand you a 
collection that we had taken in connection with our buildings. 

Mr. Snyder. Is there any gentleman here, representing any insti- 
tution, who desires to be heard? 

(To which there was no response.) 

Mr. Snyder. The county institutions who have not been heard 
through representatives will be visited by sub-committees. 

On motion adjourned. 



LEGISLATIVE COMMISSION TO INQUIRE INTO 
THE CONDITION OF PENNSYLVANIA INSANE. 



INSPECTION OF THE BLOCKLEY HOSPITAL, 
PHILADELPHIA. 

MAY lZtln, 1902. 



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INSPECTION OF THE BLOCKLEY HOSPITAL, 
PHILADELPHIA, MAY 17th, 1902. 



The Commission visited Blockley Hospital, located at the corner 
of 34th and South street, Philadelphia, Pa., on Saturday, May 17, 
1902. 

There were present of the Commission Messrs. Snyder, Chairman, 
Heidelbaugh, Bliss, McClain, Hall and Anderson, and Mr. Frank 
Cheney, assistant secretary of the Commission. 

They were received by William M. Geary, the superintendent of 
the institution, who, together with Dr. Hughes, conducted them 
through all the departments, including the insane wards connected 
with the institution and were thus enabled to inspect everything. 
They visited the women's department at a time when the patients 
were seated at the table at the noon meal, thus observing the disci- 
pline exercised. They also visited all the dormitories. In passing 
over the grounds and through the corridors they were enabled to 
inspect all the inmates of the almshouse and hospital. 

The Commission was conducted to the surgical department and 
witnessed an operation upon a patient for gangrene. They were 
also conducted to a room where the X-rays was operated and the 
physician in charge demonstrated its principles as well as gave 
several practical illustrations of its usefulness in detecting foreign 
substances in the human body. He also exhibited a number of 
photographs which showed the construction of the human body 
and displayed the X-rays in its wonderful powers as a searchlight. 
They were also shown the prison for the occupancy of intractable 
patients and found only one inmate. 

The clothing department was also visited and it was explained 
to the Commission by the superintendent that the clothing, mat- 
tresses, shoes, etc., were all made upon the premises by patients, 
thus diminishing their cost of maintenance. 

A brick building was also shown the Commission, in course of 
erection, which was explained to be for the occupancy of children or 
infants confined in the institution. 

The Commission was also shown to a room where idiots were 
confined, there being fifteen small children in the room with two 
attendants in charge. 

In passing along the Commission was shown a room where it was 
explained by Mr. Geary that every one immediately upon becoming 

(175) 



176 

an inmate of the institution was compelled to take a bath, and that 
it made no difference whether he had one an hour before he entered 
the institution; that he must be thoroughly clean before he could 
be admitted. 

Subsequently an unofficial conversation was entered into between 
Mr. Geary and the various members of the Commission and some 
questions were asked and answered, the substance of which was 
about as follows: 

Mr. Snyder (to Mr. Geary). Have you suggestions to make for the 
improvement of the laws now in existence in regard to the treat- 
ment of the insane? 

Mr. Geary. I have some suggestions that I would like to express 
to your committee. I have already stated that I would prepare 
a statement embracing certain ideas. There are some things I think 
ought to be improved. There are some things that I think 
the State of Pennsylvania ought to do. I am sure that Dr. 
Hughes and the rest of the executive staff of this institution will 
bear me out in this assertion. Therefore, I have some suggestions 
to make that I think will be useful to be applied in formulating a 
new law for the government of these institutions. 

This place is a little different from any other in the State of 
Pennsylvania, or in America. You take New York state and they 
have Blackwells Island, Ward Island and Kandall's Island, three dis- 
tinct islands and each one has its different governing head. They are 
separate and each one has an experience of his own, while here we 
begin from the birth and follow the patients to his or her death. Dr. 
Hughes has been here for the last twelve years; he has general 
charge of the hospital and charge over the insane and in that time 
a man must gain a certain amount of knowledge in order to be in 
close touch with all the necessities of such an institution and this 
is obviously of great importance. He will learn what is necessary 
and required and others who have an experience here will also learn 
much in treating these poor unfortunates. In the office where I 
am situated these strange happenings come up daily. For instance, 
at present I am trying to make a man court his own wife. They 
have been married for a number of years and they separated and 
I am now doing my utmost to get them together. I am taking care 
of four of their children and I am very anxious to get them together. 

There are a great many things occur that if I should strictly live 
up to the law in arranging them would work hardship for those 
concerned; for instance, on Monday Dr. Hughes is going to discharge 
a woman. If I would strictly comply with the law in that case 
I would turn her on the street and in less than three months she 
would be a common prostitute. Instead of doing that I am going 
to find a home for her where she will earn her own living and sustain 






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177 

heiself and be a credit to herself and the citizens of Phliadelphia; 
and I will take care of the infant by finding a home for it and having 
it adopted (if I can) in a respectable family and make a good citizen 
of it. But if I should strictly comply with the law I would say to 
the doctor in charge, "discharge that woman on the highway," 
and if that was done she would be cast adrift to shift for herself 
and be a disgrace to the community in which she would mingle. 
There are lots of things of that kind that I think would be of use 
to your committee to know when it comes to the time that you 
wish to make up your report. 

There are some things in which probably I may be a little in ad- 
vance of the times but I don't think I am too far. Since my occu- 
pancy of the office of superintendent of this institution I have been 
studying and investigating and looking up records. In the state 
of New York eighty-two or eighty-three years ago there were five 
sisters born and raised and in seventy-five years the descendants of 
those five sisters numbered 1,287 persons and every one is a charge 
on the state of New York. They constitute 281 paupers in pauper 
institutions, 91 insane and 160 prostitutes. Ten were murderers 
and the balance in some way or other became a charge upon the state 
of New York. Such facts as these, I think, are matters to be taken 
into consideration in the formulating of laws for the improvement 
of different conditions which exist in our day. I think Dr. Hughes 
will confirm me in this, knowing as we do that there are three sisters 
in the insane department of this institution, each one the mother of 
children. 

There is another vital point. I do not think it ought to be the 
easiest thing in the world to commit a person to any insane asylum. 
I do not believe to-day that there is a human being, man or woman, 
that has not some cranky notion in hh composition; the only thing 
to do is to find the handle of the crank and turn it and it will be- 
come manifest. But it does not necessarily follow that you should 
be locked up in an asylum. 

There is another thing; I directed the chief clerk to be here in 
order that he might give us any information desired on the subject 
of maintenance. Under the county act we are paid $1.50 a week; 
you get a little more than that at Norristown. but the State pays 
a little more to make up the difference. In 1891 the net cost to the 
city of Philadelphia for the patients under the care of Dr. Hughes 
was seven cents a day for 1,400 patients, or 49 cents a week for 
clothing, shoes, hats, repairs to the institution and everything. 

Mr. Bliss. Do you charge up the attendants' salaries? 

Mr. Geary. Everything, the doctors, the clerks and everything; 

12 



178 

that is the net cost to Philadelphia for maintaining its insane poor 
plus what the State gives, f 1.50. 

Mr. Bliss. I think we had better cut down the appropriation to this 
institution. 

Mr. Geary. No, I would not like you to do that. 

Mr. Snyder. That would be f 1.99 a week per capita. 

Mr. Geary. Yes, sir; this institution is an institution of the city 
of Philadelphia. The greatest number are supposed to be paupers 
but a great many prefer to come here and be treated because Dr. 
Hughes knows that the city of Philadelphia is jealous of its money 
and the better work he can do and the more patients he can turn 
out cured, the better it will be for him, therefore instead of keeping 
the patients in this institution for the purpose of making money 
he wants to turn them out as soon as he can, having in view the cure 
and restoration of the patients and whatever is for their best in- 
terest, because in doing that the better reputation he makes for 
himself. The more he cures and turns out the more credit will he 
be given as a competent man in the position he occupies and it is 
his effort to cure them and get them out as soon as possible without 
injury to the patient. He knows the better record he makes for 
himself the more secure his position will be. 

Mr. Bliss. You take care of them for less than $2 per week per 
capita? 

Mr. Geary. In some cases we collect more from the man who comes 
in. For instance, a woman comes in and we find that her husband 
has a certain income and then he is required to pay a certain amount 
of money for her maintenance. It is my duty to save as much as 
I can for the city of Philadelphia. If that man makes twenty 
dollars a week there is no reason why the city or State should pay 
for the maintenance of that woman entirely and I assess him to pay 
something towards her maintenance, not to make money but for 
the purpose of saving as much as possible to the city. 

Mr. Geary (to the Book-keeper). What was the actual cost for 
maintenance? 

The Book-keeper. Thirty-five cents and a fraction a day. 

Mr. Geary. That included my pay, Mr. Smith's, Dr. Hughes, and 
everybody connected with the department. It includes the repairs 
to the building, the roof and everything. The State gives $1.50 
towards each one; the balance, less seven cents a day, is what we col- 
lect from the relative or friends or from their own estate and it leaves 
for the city of Philadelphia the net sum of seven cents a day, or 49 
cents a week for maintaining them. If you can equal that in any part 
of the State let me know where it is. At the Boston City Hospital (I 
hope you will look at it because it is connected with the State of 



179 

Massachusetts) the cost per patient is $10.47 a week, while it is 
$2.78 and a fraction for the Philadelphia hospital; that includes 
medicine and everything and that is what brings down the cost of 
the insane department. So I think that Philadelphia can do better 
than continue to take care of its insane patients while it costs more 
than that at Norristown. We have more cures here and I will defy 
contradiction in saying that we attain better results than any other 
hospital in the county of Philadelphia. 

Mr. Snyder (to Dr. Hughes). What is the percentage of cures, take 
the admissions per year? 

Dr. Hughes. Twenty-five per cent. 

Mr. Snyder. What is it at some of the State institutions, say Nor- 
ristown? 

Dr. Hughes. About fifteen per cent. 

Mr. Snyder. What is it at Harrisburg? 

Dr. Hughes. About fifteen per cent. At Dixmont about eighteen 
per cent, and at Danville it runs about seventeen per cent; that is, 
on their yearly admissions. 

Mr. Bliss. Don't you get a good many patients of a kind not sent 
to the State asylums at all but only temporarily affected? 

Dr. Hughes. They were very prompt to take them to Norristown 
from Philadelphia when they had the room. It is within a few years 
that they asked the board of judges not to commit any more to Nor- 
ristown on account of their crowded condition there. 

Mr. Geary. Philadelphia has to-day at Norristown over 1,200 in- 
mates in the Norristown asylum, about one-half the number are 
there, and she has at Wernersville about 363. The State Committee 
on Lunacy makes a demand on the Philadelphia hospital and directs 
us to send 25 men and 5 women to Wernersville, in other words, 
to transfer them from this institution to the Wernersville hospital. 
They all come under the law of the State Committee on Lunacy 
and under the Board of Charity. They took from Dr. Hughes 25 
of the best men he had and the five best women he had, they were 
first class patients, and they would come and say we want those 
and they were sent to Wernersville.' Every one of those patients 
were practically able to support themselves, under restraint, of 
course, and we should have had the benefit of our best patients 
rather than sending them away to another institution. I thought 
that was not a "square deal" because I did not think that Dr. Hill 
should have a better chance at that institution than I should have 
here and I told Dr. Hughes that whenever an allotment is sent that 
he should select the second or third class people and let them go 
there and that we would keep the men and women that we could put 
over in the sewing room or laundry room and in that way maintain 



180 

themselves and let the Wernersville hospital take its chances with 
the rest, and we sent a few of them there and a few they sent back, 
but they are not getting our first class patients now; they are get- 
ting our second class patients and let them get the work out of 
them. 

Mr. Hall. Would not a local hospital for the chronic insane, say 
for the worst and most troublesome cases, be a benefit? 

Mr. Geary. If they were for the worst cases. 

Mr. Geary (to Dr. Hughes). As a general rule what is their gen- 
eral condition? 

Dr. Hughes. At any time after ten years they are practically help- 
less patients. 

Mr. Hall. Why shouldn't they all be taken there and these active 
ones be left to the other institutions? 

Mr. Geary. As I told your committee before, I believe these pa- 
tients should be treated within or as near their homes as possible. 
This place is visited by from three to five thousand people every 
week and if we would open the doors a little more it would probably 
run up to eight thousand people. There are actually within the 
walls of this institution 3,900 to 4,000 patients, not all insane but 
some on the road. You have the epileptic and the nervous people 
only waiting until their brain becomes befuddled and then they 
will be compelled to go to the insane asylum. There is no remedy 
for them, some senile and others affected by paresis and they all 
get in there and I don't believe in taking the chronic, the acute or 
any others very far away from their homes. 

Mr. Hall. What character of cases should be committed in case 
there is a chronic insane asylum built? 

Mr. Geary. Every one that is chronic. If you are going to assort 
the sheep from the goats; that would mean all those except the acute. 
But there are some of the chronic insane that you saw — you saw 
some people over there to-day who are practically insane but only 
insane on one certain subject. There is one little German over there 
who imagines he is Bismarck; if he remains with his friends he 
is all right but if you let him go out to the public at large he 
would be arrested by the police every 24 hours. So all through the 
place, if you would take the ones that are chronic or have certain 
delusions, they are not all entirely insane on all subjects but will 
talk to you all right on some subjects. 

Mr. Geary (to Dr. Hughes.) There is one patient over there that 
has a delusion in connection with the government? 

Dr. Hughes. Yes, sir; he has a series of delusions; he believes 
he is persecuted or libelled and wishes the United States govern- 
ment to clear him of the charges. 



181 

Mr. Snyder. He has been here since 1882? 

Dr. Hughes. Yes, sir; he has been in the asylum twenty-two years. 

Mr. Snyder. Didn't he intend to assassinate James G. Blaine at 
one time? 

Dr. Hughes. No, sir; that was misconstrued at the time; the fact 
of it was that he wanted him to take him to the man that assassi- 
nated James A. Garfield. 
Mr. HalJ. Is he dangerous? 

Dr. Hughes. At times he is very dangerous. 

Mr. Hall. If you were going to select ten men to be sent to the 
Wernersville asylum would you put him among the number? 

Dr. Hughes. No, sir; not under the law. The law requires that 
they shall be able bodied and quiet patients. 

Mr. Geary. The law says that they shall be able to do labor: 
Manual, mental or otherwise, as you and I could. That is what 
Wernersville is. Now there are men from here doing clerical work 
at Wernersville and doing farming at Wernersville and who also 
run the machinery and there are women from here waiting on the 
table and working in the laundry. Wernersville was established to 
be a self supporting institution. 

Mr. Bliss. That was the object of the Wernersville institution, 
that they should support themselves at the lowest possible cost. 
It cost them something over two dollars a week for maintenance. 

Mr. Hall. Couldn't you send away from this institution fifty men 
who are practically incurable and it would be best for you? 

Dr. Hughes. Yes, sir. 

Mr. Geary. Let me take from fifty or five hundred and take them 
away from here; they finally grow mellow; to-day they are hearty 
and healthy physically. In a little while their relatives come here 
and visit them under the supervision of Dr. Hughes. After a little 
while they are not dangerous or vicious and their friends take them 
and support them. 

Mr. Hall. They would not number five hundred? 

Mr. Geary. W r ell, I think I can cite seventy-five or one hundred put 
on parol in a day. 

Mr. Snyder. Wliat are the percentages of cures at Wernersville? 

Dr. Hughes. They say they discharge about five per cent, every 
year. 

Mr. Geary. Chronic means anything you cannot cure, as when 
you have a chronic habit or chronic disease that is supposed to be 
incurable, but yet they turn out five per cent! 

Mr. Snyder. Of those twenty-five per cent, that you turn out as 
cured how many return, or are sent to an insane asylum? 

Dr. Hughes. Of a given percentage absolutely cured, say twenty- 



182 

five per cent, we will discharge and not over ten per cent, of them 
will ever return. We have watched that here for a number of years 
and of the twenty -five per cent, fifteen per cent, are absolutely cured 
and ten per cent, may come back. 

Mr. Geary. As I said before, and as Dr. Hughes will verify me, 
between fifty and sixty per cent, of the patients that are here are 
here because it was born in them and will stay in them; there is 
no cure for them. It is like scrofula and there has never been 
any medicine created to take it out. Prevent the cause and you will 
have the best result. 

Of course there are some men who come in here who have been 
bright and intelligent men and who have for some cause or other 
lost their mental capacity. It may be from some excessive prac- 
tice, from family troubles or financial difficulty. That is the trouble 
with us all, we are trying to crowd in the twenty-four hours what 
the quiet fellow will take a week to do and we go on and on, rush- 
ing into this and that, and do not stop creating causes. 

Mr. Snyder. In these idiotic cases are they mostly attributable 
to the parents? 

Dr. Hughes. It is very hard to get a history from the parent of 
an imbecile child; they don't want to tell and will not tell the 
truth. 

Mr. Geary. At Number Vine street, they have two children 

and the woman has since said that she will have no more for the 
reason she knows that every child she brings on earth will be an 
idiot or feeble-minded. There is down in one of the lower wards 
seven children and every other one is an idiot and the woman was 
married to another man before and had ten children and every one 
of those ten children are as clear as any one. 

Mr. Snyder. What percentage of insanity is traceable to syphilis? 

Dr. Hughes. Very small. 

Mr. Snyder. How much to consumption? 

Dr. Hughes. Three or four per cent. 

Mr. Snyder. How much to alcoholism? 

Dr. Hughes. That is not near as large as it was at one time. It 
is supposed that the alcoholic who become insane have been born 
deficient; that there has been some mental enfeeblement that the 
alcoholic practice has made them insane. 

Mr. Geary (to Dr. Hughes.) I want to ask Dr. Hughes this ques- 
tion: A man, cohabiting with a wife, under the influence of liquor, 
intoxicated, what will he produce? 

Dr. Hughes. He will produce a child that in time, about that age, 
will become a drunkard, or run a risk of being an epileptic or a 
drunkard. 



183 

Mr. Snyder. How about masturbation? 

Dr. Hughes. Not near so common a cause. 

Mr. Snyder. How about acute nervous diseases? 

Dr. Hughes. A large proportion. The great increase in the pop- 
ulation in the last twelve years has been followed by an increased 
percentage of patients from nervous debility, or neurasthenia, which 
resulted in melancholia. They are prolonged cases in a vast ma- 
jority of instances. 

Mr. Bliss. How many business men, who are capable of transact- 
ing a small amount of business — how large a proportion of them? 

Dr. Hughes. We don't get that character of patients. 

Mr. Geary. They object to coming here but they are coming here 
more to-day than they did five years ago. Those that objected to 
coming here at one time prefer to come here because they 
have learned that it is to the interest of the authorities 
in the Philadelphia hospital to produce as large a number 
of cures as possible. They learn that and in consequence 
they come here and a man gets nearer home and the nearer home 
he gets the more he is watched by his friends because of the better 
opportunity to get to see him; while if they are sent to Pittsburg or 
Allegheny they do. not get there so often, probably twice a year. 
The doctor will tell you that there are a number of them here who 
are never visited but that is because they have no friends. Only 
quite recently a woman died in this institution who was committed 
to the hospital in 1845, Mrs. Isabella White, she was here fifty-six 
years. She was committed on the 12th of December, 1845, and 
at the end of this year, December, she would have been here fifty- 
seven years. Nobody visited her; there was not a friend to claim 
her body when she died. If she had been far removed there would 
have been excuse for her relatives not to come if she had any, but 
she had none. 

Mr. Hall. Have you ever made a study of the subject of contract- 
ing patients out, or boarding them out, similar to the system that 
is in practice in Belgium, where they put them out through the 
country? 

Dr. Hughes. That system originated in Scotland. However, it 
is done in Belgium. In Scotland there are probably a thousand 
every year under the Board of Charities for Scotland. They simply 
take the chronic incurable, the quiet insane, such as we are sending 
to Wernersville and having families take them, where they have 
small farms and having them do some kinds of work that they are 
able to do. They take them and support them and sometimes pay 
them a revenue. 

Mr. Geary. It is similar to what you are doing in this State. 
There are about thirty counties in this State that are putting them 



184 

out at auction, putting them on the block and selling them to the 
lowest bidder. 

Mr. Hall. Do you think it would work in this State? 

Dr. Hughes. No, sir; I don't think it would. It was tried in 
New York state and it was a failure. 

Mr. Bliss. It is impossible to look after them when they are scat- 
tered around in different sections in tha< way? 

Dr. Hughes. Yes, sir. 

Mr. Geary. To-day, in Pennsylvania, slavery exists. There are 
counties in Pennsylvania where if I am a pauper and I am without 
capacity to take care of myself they put me up on the auction blocl' 
and ask you gentlemen how much you will keep me for: Ten, twenty, 
twenty-five or thirty cents a week and where a man thinks I am a 
hearty eater they will ask more. That is done all over the State 
of Pennsylvania. 

Mr. Bliss. As a rule they are very well taken care of? 

Mr. Hall. Very frequently they are placed among persons whom 
they know. 

Mr. Geary. They look upon these people from the standpoint of 
their age, their ability to take care of themselves, their ability to 
do something and all that is taken into consideration and then 
they say how much they will keep them for per week or per month. 

Mr. Snyder. Do you think that if these counties erected separate 
insane asylums, like in Chester county and Luzerne county, that 
they could take as good care of the insane as can be taken care of 
them in hospitals like this? 

Dr. Hughes. Yes, sir; I think so. 

Mr. Hall. That must pre-suppose a building erected for that par- 
ticular purpose? 

Dr. Hughes. Yes, ©ir. 

Mr. Geary. You saw those old buildings, which were erected fifty 
years ago, and I defy contradiction of anybody connected with any 
State institution in Pennsylvania to take such promiscuous build- 
ings and produce more cures than Dr. Hughes has done here. 

Mr. Hall. Were not those buildings erected for that time? 

Mr. Geary. Yes, but you take your profession and they did not do 
what they do to-day in it. It is necessary to keep up with the rapid 
progress of the times and keep in touch with everything that will 
promote the best interests of the institution. 

Mr. Hall. I agree with you in that. I know I went on a city news- 
paper in 1884 and the methods are very different now from what 
they were then in the transaction of business. 

Mr. Geary. It is the same way with the insane. 

Mr. Snyder. Suppose three or four small counties went together 



185 

and by mutual agreement erected an asylum among them, wouldn't 
it be practicable for them to do that? 

Mr. Geary. It would, and I said so the other day. You gentlemen 
of the Legislature formulate laws for the State of Pennsylvania. 
You say that Philadelphia is one judicial district; not long ago you 
had Bucks and Montgomery counties for one judicial district and 
you found it was getting too large with one set of judges and by 
the power and authority vested in you through the Legislature you 
divided them and made separate judicial districts. Why should 
you not divide the insane districts in that same way? 

Mr. Snyder. In addition to having county institutions what State 
institutions would you have, would you have one for the criminal 
insane? 

Mr. Geary. No, sir, 

Mr. Hall. Not for the convict insane? 

Mr. Geary. No, sir; I would let each and every county keep its own 
insane. Dr. Hughes takes care of Barnhart over there and there 
is no worse criminal in America than he is. 

Mr. Hall. Suppose a man was put in the penitentiary and become 
insane wouldn't you distinguish between a man who was acquitted 
of a crime because of insanity and a man who became insane after- 
wards? 

Mr. Geary. I would not because a man who becomes insane after 
he commits a crime is also a man without reason; his former condi- 
tion in life has nothing to do with his present condition. Take a 
man like Malcolm Ford, who murdered his brother, I suppose he was 
insane when he committed the act which resulted in the death of 
his brother; he is committed to an asylum, would you say he should 
go with the burglar and murderer, a man who pursued a lifetime 
of crime and was committed because of insanity? Both have lost 
their reason. Take this illustration: A man like myself, I have 
committed no crime that would hang me, suppose I went insane and 
after I was insane I would do that, why should I be ostracized? 
Why should I be put in a place with a man who has been a criminal 
all his life. How different should I treat you than the one who has 
been insane? I don't believe that when a man has once lost his 
reason that there i« any sensibility, but that any finer feelings of 
sensibility are all gone. 

Mr. Hall. I heard one of those women at the table protest and say 
within our hearing, that she had not been accustomed to associate 
with that class of people. 

Mr. Snyder. What classification would you have in the State insti- 
tutions? 

A. I would not have any. I would do this: if I was regulating 



186 

this whole business I would place every insane person in charge of 
their own municipality. The county of Philadelphia, created by 
you gentlemen, or your predecessors, made it a municipality. You 
gave it certain rights within certain bounds and having that power 
you can provide for its doing other things within certain bounds 
and I would make it take care of its own people, the insane, the 
criminal insane and every other class, and likewise the counties 
should be compelled to take care of its own. 

Mr. Bliss. Every municipality has hoisted upon it many who do not 
belong to it, what would you do with those? 

Mr. Geary. Then do like we do. I am receiving them from Alle- 
gheny county to-day and from Delaware county pay patients in this 
institution. 

Mr. Bliss. Suppose it happens to fifty or five hundred who come 
across the line from Delaware and Jersey, what are you going to 
do with them? 

Mr. Geary. Send them back. 

Mr. Bliss. That is impossible and furthermore it would be inhu- 
man to do so. 

Mr. Geary. The Commissioner of Charities of the state of New 
York sent to me within six weeks word that they had a man who 
is a citizen or resident of Philadelphia. He proved to me before 
the man came here that he was a resident of Philadelphia and I 
accepted him and placed him in the institution. 

Mr. Bliss. You have heard of the case of the Norwegian sailor, in 
Delaware county, who became afflicted with leprosy, there was 
no place to send him and he could not be sent back to Norway; the 
county of Delaware had to take care of that man for ten or fifteen 
years, up until he died. 

Mr. Geary. That is one of the exceptions that proves the rule. 

Mr. Bliss. It is one of the hundreds of cases in all the asylums and 
institutions of the State. 

Mr. Geary. In this institution we receive from the immigration 
office all kinds of foreigners. They telegraph us from the steamship 
landings that there is one, two, three and as high as a dozen. At 
the time they land here they come here as pauper patients but the 
United States government pay us. The sergeant of the Marine 
hospital comes here and examines them and he goes back to Mr. 
Rogers and tells him that Mr. So and So is cured and we discharge 
him and the government pays us and in one year they are citizens 
of Philadelphia. 

Mr. Bliss. Suppose they come from New York, what is done with 
them? 

Mr. Geary. We keep them. 



187 

Mr. Hall. Here is a wonderful institution but it belongs to a county 
with a population of over a million people. You go with me to 
Forest county, Cameron, Pike or Adams county and go to the alms- 
houses and you find the conditions very different. Would you send 
the insane to those almshouses? 

Mr. Geary. I would, under the law as passed at Harrisburg, compel 
those counties to provide the necessary facilities to take care of 
those people. Every county of the State has a physician attached 
to it and sometimes they don't go there. 

Mr. Snyder. How are the children sent to Ellwyn? 

Mr. Geary. The city councils of Philadelphia has made an appro- 
priation which allows me to send 160 children there at $175 per 
year for each child. That many go there and you are the ones 
that designate who you wish to send there and when that quota 
is filled they notify me that they have the requisite number. In 
Philadelphia each member of the House and Senate gets a certain 
number allotted until the quota is filled. They make a certain 
application through the request of some of their constitutents and 
these children are sent there in charge of a physician and if they 
are found to be curajble they are kept. I have letters to-day to 
some members with some such statement as this: "I am very sorry 
to tell you that John Jones who wants his son Jimmy Jones admitted 
to Ellwyn cannot be admitted because of inadequate appropriation. 
We suggest that you see Geary of the Gity Charities and probably he 
can help you." I take that up and do the best I can and I sent one 
to Dr. Hughes this morning but I do not have much to do with that 
as I depend on Dr. Hughes because I am not a professional man. 
He reports to me that Jimmy Brown, giving another illustration of 
its workings, that Jimmy Brown was examined this morning and is 
so and so and I think he will improve in a year's time at Ellwyn, 
and in that way our quota is filled and when my quota of 160 is 
filled I stop. I have plenty of cases that I don't think ought to 
go to Ellwyn. Ellwyn was originated by Dr. Kerwin; it was not 
chartered for a Home but for feeble-minded children. Last summer 
I took Dr. Hughes and a few nurses and we went there* and we asked 
for our children and they brought them all in and Dr. Hughes and 
others made a personal examination and a physical examination of 
them there. I just sat there and glanced them over, not being a 
medical man, but I formed my own opinion about them. We came 
back and I took away thirty-two people, the oldest forty-one years 
old and the youngest twenty-six years old. Less than three weeks 
ago there was a man in Ellwyn seventy-five years old and he was sup- 
ported by the State; I don't think a man at seventy-five years of 
age is much of a child. 



188 

Mr. Heidelbaugh. I thought that was intended as an institution 
for patients who were improvable? 

Mr. Geary. Exactly my view and for that reason I took thirty-two 
away from there. Up there in the kitchen is a man that has my 
clothes on; he is a large, stout and robust looking man and he 
goes around and says that he is the superintendent of the insti- 
tution and jet that man earns every cent that it costs the city of 
Philadelphia to maintain him. He was taken from Ellwyn and is 
about twenty years of age. I would rather eat a chicken cleaned 
by him than by many who are employed as experts in the business. 

There are two things for your committee to do, first, revise the 
law as to committing patients to the insane asylums. Second, you 
want to buy a home for the State to provide a place for the idiots 
and imbeciles. You saw those children downstairs (meaning the 
idiots); they were in excellent humor to-day; I am sorry they were 
not in their regular tempers for you would have run out of their 
room had we found them as they usually are. 

Mr. Snyder. Where do you put them after they get older? 

Mr. Geary. They stay there until their brain gets less and less 
and they land over there (pointing in the direction of the insane 
asylum). 

Mr. Bliss. How long do they live? 

Mr. Geary. I could not say. 

Dr. Hughes. About as long as any others. 

Mr. Geary. You gentlemen passed a law last winter and the Gov- 
ernor vetoed it; it was just what I wanted and you ought to pass it 
again. It was what was known as the Willard bill for the pre- 
vention of idiots. That bill was all right and I am very sorry that 
the Governor did not sign it; it will come to that yet. You have 
to pass those kind of laws to make this Nation stronger and better 
and the people in it unaffected by mental weakness. If you let 
it go on after while we will be a Nation of weak brains and many 
lunatics. 

Mr. Hall. That never was impressed upon me so much as it was 
to-day and seeing these people as we have seen them. 



LEGISLATIVE COMMISSION TO INQUIBE INTO 
THE CONDITION OF PENNSYLVANIA INSANE. 



Inspection of the State Institution tor Feeble-Minded of West- 
ern Pennsylvania at Polk, Penna. 



MAY 26th, 1902 



(189) 




( 190 ) 



INSPECTION OF THE STATE INSTITUTION FOR FEEBLE- 
MINDED OF WESTERN PENNSYLVANIA AT POLK, PENNA., 
MAY 26, 1902. 



The Legislative Commission, to investigate the condition of the 
insane, left Broad street station on May 25, 1902. When the Com- 
mission arrived at the Polk institution there were present of the 
members Messrs. Snyder (chairman), Marshall, Heidelbaugh, Bliss, 
Hall, Anderson and McClain, together with Frank T. Cheney, as- 
sistant secretary, and J. F. Cumings, stenographer. They arrived 
at Polk, Pa., on Monday, May 26, 1902, at 12.30 P. M., and were met 
by Dr. J. M. Murdoch, superintendent, together with Doctors Weaver 
and Mossman. 

A tour was made of the entire series of buildings composing 
the institution' for feeble-minded. Each ward was visited and the 
inmates seen who were there at that time. The Commission were 
shown through the various dining rooms while the inmates were at 
dinner. An inspection was made of the sleeping rooms and the 
stair-cases leading from one floor to the other, including the fire 
escapes, in order to determine the adequate of escape in case of fire. 

The school rooms were next visited in which classes of children 
were being instructed and the methods of instruction were ex- 
plained. In the kindergarten department the children were engaged 
in making various trinkets similar to those made in other schools of 
a like character. In the workshops a number of the inmates were 
found employed in carpenter work, carpet weaving, making stock- 
ings by the use of knitting machines, making mattresses for the 
use of the institution, assorting of hair for the same, making of 
brooms, etc. In the shoe department shoes were being made and 
repaired; the tailor shop was busy with clothing for the use of 
inmates; and another shop was used for chair making and repair- 
ing. In all these various departments the work was being done by 
the patients, the head of the department alone being a paid attend- 
ant. In the laundry the Commission had an opportunity of seeing 
the inmates at work at all kinds of laundering, including the opera- 
tion of a mangle. The power house, the store room, the refrig- 
erator or cold storage were examined. In the hennery incubators 
were in operation. In the stables it was stated that there were 
seventy-five cows and sixteen horses kept for the use of the insti- 

(191) 



192 

tution. The water reservoir was empty at the time for the purpose 
of cementing the bottom, the size being 100 feet square by 12 feet 
deep; it furnishes water throughout the entire plant by the gravity 
system. 

In the evening the Commission visited the chapel, where earlier 
in the day several classes of children had been seen engaged in 
various calisthenic exercises. All the inmates, who could be brought 
from their rooms, were brought to the chapel wuth nurses in charge. 
A band composed of inmates furnished music to which the childreu 
danced. There were also some games played in w T hich they took 
part with great zest. 

During the afternoon the Commission saw two Cretins, deformed 
and helpless idiots, one 39 and the other about 30 years of age, 
both being females; the one 39 years of age was 30 inches high. 
There were several cases of Microcephalous children, one being a 
woman grown; three of these, two girls and a boy, are brothers and 
sisters. The Commission also saw the inmates at their exercises 
walking about the grounds in charge of their attendants. 

The piggery was also inspected, where shoats of all sizes were 
being cared for. The boys' garden was also shown the Commission. 
It was stated to the Commission that 4,000 bushels of potatoes were 
raised annually. All the articles made and produce raised, however, 
may be ascertained in the printed annual report of the institution. 

A formal meeting of the Commission was held in the reception 
parlor of the institution where Dr. Murdoch answered questions 
propounded to him by the chairman and other members of the 
Commission, a report of which is hereto attached. 

Dr. J. M. Murdoch testifies as follows: 

Q. (By Mr. Snyder.) Of the patients you have in this institution 
what percentage are epileptic, or have an epileptic history? 

A. We have about two hundred, between one hundred and fifty 
and two hundred, being from twenty-two to twenty-five per cent, 
epileptic. 

Q. What per cent, of cures, or supposed cures, do you have of that 
number? 

A. It would be quite small, not more than 10 per cent. 

Q. (By Mr. Hall.) You mean of the 22 to 25 per cent? 

A. Yes, sir; that 10 per cent, would indicate about the percentage 
of the feeble-minded, of those whom we receive and who are fit to 
go out into the world. We occasionally get children where the 
apparent condition is due to some disease which can be corrected, 
or through some lack of training of sense which can be remedied by 
training. 

Q. (By Mr. Snyder.) What is the family history or great percentage 
of the cause of it? 



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193 

A. We find heredity plays an important part in the cause of it. 

Q. (By Mr. McClain). Doctor, of this number that you send away 
as cured is it likely that they will transmit to posterity their malady, 
I mean of the epileptics, you say about ten per cent, are sent away 
cured, now of that number you sent away as being cured, in your 
opinion, could they transmit to posterity their malady of which 
they were afflicted, if they had any? 

A. Yes, there is danger of that. 

Q. 1 want to ask another question: What remedy could be taken 
to prevent that being transmitted to posterity on the part of those 
who had been afflicted and sent away as being cured? 

A. By being unsexed. 

Q. Castration? 

A. Yes, sir. 

Q. That is the only remedy you know of? 

A. Yes, sir. 

Q. (By Mr. Bliss.) Not necessarily castration? 

A. We call it castration. 

Q. (By Mr. McClain.) You call it unsexing them? 

A. It is the same thing. 

Q. (By Mr. Bliss.) You could unsex them without destroying the 
desire of sexual intercourse but still destroy the power of procrea- 
tion? 

A. Yes, sir. 

Q. How could that be done? 

A. There is a tube known as a "vas deferens" which connects the 
testicle to its outlet into the uretha where it discharges; by taking 
a piece out of this tube the semen is prevented from finding an 
outlet and thus preventing procreation and at the same time you 
don't castrate or affect the feelings of the patient or individual with 
reference to the desire for sexual intercourse. 

: Q. Is it not unsafe to turn back into society anybody who has 
been afflicted with epilepsy without providing against sexual inter- 
course? 

A. I think it is. 

Q. (By Mr. Hall.) Is it not unsafe to return to society the im- 
provable cases who are not affected with epilepsy? 

A. If we had the room and accommodation and could provide 
suitable accommodations for those affected and teach them to lead 
useful lives and be put under restraint through the benefit of this 
institution it would be far better for them to stay here. 

Q. Take a case that is improvable; you cannot eradicate a certain 
instinct possessed by the patient? 

A. That person can be very useful in the institution, more so 
13 



194 

than anywhere else, on account of the nature of the training he 
will receive here but we are so pressed for the admission of cases 
of extreme distress and where families are destitute, in fact where 
the whole family may be destitute on account of having to look after 
one imbecile and on that account we are forced to take them. 

Q. (By Mr. Snyder.) There are a certain number of cases where 
the epilepsy is caused on account of pressure at the time of birth 
and in those cases they may never have had epilepsy in the family, 
but those cases are congenital you speak of? 

A. Yes, sir. 

Q. What do you suggest as the best care and treatment for the 
epileptics, would you have them in separate hospitals or separate 
wards if you had the room that was needed for their care? Would 
you have a separate institution or separate ward, if you could have 
all the room you needed? 

A. I think a separate institution for epileptics would be a very 
fine institution for the State. 

Q. Have all grades of epileptics there, but have them graded 
according to the severity of the case? 

A. Yes, sir; there are those who have studied this subject more 
than I have but that would be my view of it. In New York and 
Ohio there have been very successful institutions established for 
epileptics and I think the colony plan would be the best in this 
State for the epileptics. I think we should be guided by the ex- 
perience of others. 

Q. In Chester county I don't think they take all classes of epi- 
leptics; the institution is located just outside of West Chester and 
is a colony farm? 

A. They are limited in capacity. 

Q. They are always filled and when they have a vacancy they 
are very glad to fill it with some worthy case but they are hampered 
for room. Is the majority of cases of feeble-mindedness inherited? 

A. Yes, sir. 

Q. About what percentage? 

A. About 60 per cent. 

Q. What does the other 40 per cent, usually come from? 

A. About 20 per cent, of the other are children of intemperate 
parents, the effect of excessive habitual use of alcohol in father 
or mother, particularly of the mother is what, in a great many 
cases, causes imbecility. Children begotten in a condition of drunk- 
enness will be imbecile. Another large majority are children of 
those afflicted with tuberculosis, or consumptives; and then another 
small number are those due to parents of excessive -habits and chil- 
dren of those who have worn out their sexual powers and have. 



195 

venereal diseases. The percentage of children who are the result 
of syphilis is not so large as you would suppose; I think in our 
institution it would be about two per cent. Then there is another 
class where injury results at the time of delivery because of great 
pressure on the head owing to the size of the vagina from which 
the child is delivered and great pressure made on the head may 
cause injury to the brain and bring about imbecility. 

Q. Especially where delivery with instruments is adopted? 

A. Yes, sir; sometimes on account of that and the very fact that 
instruments are used shows that the parts are not large enough. 

Q. (By Mr. Bliss.) Speaking of heredity, do you carry it back be- 
yond the parents? 

A. I pointed out to some of you to-day the three children who 
have very small heads. I am able to trace their family history 
back to their great grandmother. In the early part of the last 
century there lived in a town in western Pennsylvania a feeble- 
minded girl who married a man well advanced in years. They had 
four children, all girls and all were mentally deficient. The father 
died leaving the mother in destitute circumstances. The girls grew 
up in ignorance, ran the streets and all gave birth to illegitimate 
children, I think the number is eleven. One of these feeble-minded 
children, a male, grew up in ignorance a dissolute, worthless char- 
acter of no intelligence, unable to read and write, but married and 
had five children, all of whom are of an extremely low grade of 
idiocy. The oldest is about fifteen or sixteen years of age; he is 
a paralytic and an epileptic, as well as being an idiot. The second 
child is a boy of about nine years of age and is unable to talk and 
incapable of receiving instruction; he requires to be cared for as a 
babe. The third child, a girl about seven years of age and the 
fourth a boy about five years of age have little more intelligence. 
The fifth child, about one year old, is apparently idiotic, although 
too young to prognosticate the extent of the mental enfeeblement. 
All these children have extremely small heads and are all under 
sixteen inches in circumference and are what is known as micro- 
cephalous. The inference from thi® case is very clear: Had the great 
grandmother been placed in an institution for the feeble-minded 
fehe could no doubt have been usefully employed, being at least self 
helpful. She would have led a happy existence and would have 
died without issue. As it is there is evidence that in the neighbor- 
hood of a hundred of her progeny are depending upon the charity 
of the people for their maintenance. These three children are chil- 
dren of one of the illegitimate children and we have other children 
here who are descendants of this same grandmother; besides those 
three we have one great grandchild of that woman v^o is a her- 
maphrodite, 



196 

Q. Does it often happen that mental weakness occurs in one 
generation and will pass over one generation and appear in the 
next? 

A. That is said to be the case. I have .not collected any data 
on that subject and therefore have no personal knowledge of that 
kind of anatomism. 

Q. There is something in anatomism? 

A. Yes, sir; we have a case of a child born of a brother and sister. 
The mother was a washerwoman, a widow, whose husband died in 
the hospital for the insane at Dixmont. She took in washing and 
it was necessary during her absence to leave these two children, a 
girl of eighteen and a boy of twenty, in the house, thinking they 
w r ere as innocent as babes but the result was that the girl gave 
birth to a little baby and that child is here with the mother; she is 
four years old and she is like a child of two years old, but she is 
remarkable for having such a family history; she has much more 
intelligence than either her father or mother. 

Q. (By Mr. Bliss.) What is the nature of the child's defect, simply 
weakness of intellect? 

A. Yes, sir; that is all. There is arrested development; there is 
less development in body so far. 

Q. (By Mr. Snyder.) What is the history of that little child, the 
baby of the institution? 

A. That is the one I have reference to. 

Q. The little girl dressed in white, I mean the one that the doctor 
picked up dressed in white? 

A. Yes, sir; that is the one. 

Q. Is that the case you speak of where the parents are brother 
and sister? 

A. Yes, sir; it is remarkable that she is as clever as she is. 

Q. (By Mr. McClain.) Were the father and mother both imbe- 
ciles? 

A. The mother has quite bad nerves, some of the nerves being 
partially paralyzed. 

Q. Do you have mother and father both here? 

A. No, sir; only the mother. 

Q. (By Mr. Hall.) Are there any of these people so devoid of mind 
at all that they would not gratify the animal instincts, if there was 
an opportunity? 

A. There is a class, I think, that do not have any sexual passion. 

Q. But the majority certainly would? 

A. Yes, sir; a majority of them would. It is in the higher grade 
that there is more likelihood. It is easy enough to watch and pro- 
tect the lower grades on such occasions. 



197 

Q. The reason I ask you is because we went into the toilet room 
where some of those boys were being attended to and they were 
very bad looking creatures. 

A. It is very doubtful whether they have physical power; they 
would be hopelessly gone; they are in the third and fourth genera- 
tion, beyond hope. 

Q. (By Mr. Bliss.) In your judgment would there be any material 
benefit in the operation of such a law, if there was a law to authorize 
such operations in an institution of this kind, if it did not authorize 
a similar operation upon those of the same character who are not 
in such institutions? 

A. I think the passage of such a law would be a good thing. How- 
ever, I think it would be very well to give the performance of such 
duties into the hands of skillful men. 

Q. Do you think there would be any material benefit resulting 
therefrom if it was confined to large institutions and it did not 
apply to those outside of the institutions, and in connection with 
that can you give us the proportion of all the imbeciles and epilep- 
tics of this State who are in institutions of this kind and what pro- 
portion are at large? 

A. Your question is whether I think it would be advisable to 
have a law making it possible to operate on inmates in institu- 
tions of this character if it did not apply to individuals of the same 
character outside of the institutions? 

Q. Yes, sir. 

A. I think it would be better possibly — I don't know just how to 
answer that. 

Q. Let me ask another question: Whether there are as many 
inside of this institution as are outside, according to the best of 
your knowledge? 

A. According to the statistics there are eight or ten thousand 
in Pennsylvania and about two thousand in the institutions. 

Q. Would there be any benefit to pass a law to affect the two 
thousand in the institutions unless the law authorized the same 
operation to be performed on the six or seven thousand outside of 
the institutions? 

A. It would be a trend in the right direction if it would affect 
them, otherwise it might be a preventive to those outside from 
coming to such institutions. 

Q. Wouldn't it be a good thing to have a law to permit the 
medical profession, under some restrictions, to perform an operation 
on those who are not inside of such institutions? 

A. With the consent of the parents? 

Q. No, sir; I would say under some kind of compulsory judicial 



198 

control, such as would secure an open proceeding in order to prevent 
the abuse of the authority but which would not subject the medical 
operation to the mere whims of the parents — wouldn't it be a good 
thing to give the medical profession the right to perform such an 
operation to those outside because the State has not provided an 
institution for them? 

A. Yes, it would be a good thing. 

Q. That is, to have a general law affecting those inside of the 
institutions as well as those outside, so that those outside might 
have some judicial protection? 

A. While they are in the institution the institution should be 
so governed that accidents of that kind should not happen, although 
accidents of that kind might happen in the best regulated families. 
We have to have a much closer restraint on a class of children who 
are very useful and we could give them a broader field of usefulness 
if that was enforced. 

Gen. Wiley. In the passage of a law, unsexing only those within 
the institutions, it would have a tendency to depopulate the in- 
stitutions for the reason that the parents would most likely take 
them out as far as they were able to do so and take them under 
their own control, which is very meagre at best. 

Mr. Snyder. Where the parents had a reasonable amount of sense 
you think they would resent it and oppose it? 

Gen. Wiley. I would say that any parent who has a child in an 
institution, it matters not what a monstrosity it would be, would 
take them out of the institution if they know the surgeon was going 
to use a knife upon them. 

Dr. Murdoch. There are some parents who would do that. 

Q. (By Mr. Hall.) How much interest do the parents manifest 
towards their children in the institution, as a rule? 

A. They are very solicitous as a rule. 

Q. Take the parents of those three children with small heads, 
what interest do they take in them? 

A. I get letters every month; they are not able to write but 
they get some one to write inquiring about them. 

Q. (By Mr. Snyder.) Do the children resemble the parents, or 
are they much more defective than the parents? 

A. They are much more defective than the parents. 

Q. (By Mr. Hall.) Supposing there were a law passed at the next 
Legislature authorizing that operation to be performed on the 
inmates of institutions, such as this, what proportion of these 
people would you operate on as an approximate number? 

A. I would proceed very slowly; I would not operate on very many 
the first year. 



199 

Q. (By Mr. McClain.) You say an operation can be performed 
that would destroy the power to create but would not deprive them 
of the enjoyment of sexual intercourse; if they have the power to 
have sexual intercourse, the thing to do is to take away the power to 
create? 

A. Yes, sir; that is the important thing. 

Q, (By Mr. Hall.) Is there not more danger from the feeble- 
minded, in girls becoming the prey of men who are all right phy- 
sically, that is, physically and mentally but not morally, than there 
is in boys? 
* A. Very much more so. 

Q. Can you perform such an operation too? 

A. Yes, sir; that was the idea of the law, to cover both classes. 
My idea, after all, has been to get these children in the institutions 
as a means of decreasing imbeciles; it is not a question whether 
they can or cannot create, it is better for them to be here in the 
institution. 

Q. (By Mr. Snyder.) Wouldn't it be better to have enough insti- 
tutions to take care of all feeble-minded, if applications were made? 

A. I feel confident if there were enough accommodations for all 
who would apply, that the number instead of increasing would de- 
crease. 

Q. There is danger, if such a law is passed and it did not apply 
to all, that there might be some most necessary to be operated upon 
who would be kept in security for the time being, where if all classes 
were kept in an institution they would be kept separate? 

A. Yes, sir. 

Q. (By Mr. Bliss.) How many institutions, the size of this, is 
necessary to take care of all the cases in Pennsylvania? 

A. Well, there are eight hundred in the State now; these insti- 
tutions could be enlarged. 

Q. How many could this institution take care of? 

A. We are crowded with eight hundred and twenty-seven, but 
this institution could be increased to take care of two thousand. 

Q, How many institutions of the size of this would we have to 
build to take them all inside of State institutions? 

A. I think if we had three institutions of the size of this we 
could accommodate all that would make application. There are 
some who are taken care of by their parents and there is not the 
same danger from them as those who wander on the streets. 

Q. Does the law require the parent's consent before a child may 
be admitted here? 

A. Yes, sir. 

Q. Do you not think that is a bad provision in the law; in other 



200 

words, don't you think that there ought to be some way to commit 
feeble-minded children, similar to the law that the insane are com- 
mitted through the courts? 

A. I think if parents are able to give good care and attention at 
home, proper and necessary care, that they should not be separated 
from each other. 

Q. (By Mr. Snyder.) There are a great many feeble-minded chil- 
dren taken care of in the county institutions? 

A. Not so many now. When this institution was opened we re- 
ceived something over three hundred from various counties in west- 
ern Pennsylvania. 

Q. (By Mr. Bliss.) What is the age of the oldest inmates here? 

A. I could not say but we have men here over sixty years of 
age. 

Q. How many inmates have you in this institution? 

A. There are 827, about 150 of whom are over the age of 20 
years. 

Q. Don't you think it would be wise to provide only for the 
admission of inmates to a certain age after which the feeble-minded 
should be treated as insane and sent to insane asylums instead of 
keeping them here, except the epileptics? 

A. I don't see what you gain by sending them to any insane 
asylums. 

Q. Are they not practically insane adults? 

A. They are harmless; they are imbeciles; they are not unlike 
what we call dements. The chronic insane are supposed to be able 
bodied. 

Q. What is the difference between a sixty year old child and a 
sixty year old insane man? 

A. It depends on the form of insanity; he is very similar to an 
insane man under what you call dementia; unless you knew the 
history you could not tell them apart. 

Q. Don't you think it would be best to confine the treatment of 
children to some condition of betterment up to a certain age, and 
if they are not curable and have passed that age, send them to in- 
sane asylums? 

A. I would not send them to insane asylums unless it would be 
to such a hospital as at Wernersville — either county insane asylums 
or to the hospital for the chronic insane but not to the acute insane 
hospitals. In New York they have such institutions. 

Q. What is your idea of the proportion of the acute and chronic 
insane, are they not almost all insane? 

A. Almost all; the proportion of the chronic insane I don't sup 
pose is 10 per cent. 



201 

Q. If that is the case do you think it is necessary to have an 
asylum such as there is at Wernersville? 

A. I never thought that was a very good move. 

Q. (By Mr. Snyder.) Do you place certain patients as near alike 
in mental capacity together, that is, you don't put the very weak 
minded ones with the improvable grade, you grade them? 

A. We do the very best we can. 

Q. You grade them the best you can? 

A. Yes, sir; but our institution is not suitable for proper grada- 
tion. We should have buildings where the helpless and the unim- 
provable cases could be cared for entirely separate from the im- 
provable. They all, more or less, come together in the dining 
room and the arrangements are such that they must come in con- 
tact with each other. 

Q. The association with each other is some menace towards their 
recovery? 

A. Yes, sir. 

Q. (By Mr. Bliss.) Is there any difference between the physical 
feeble-minded and the adult insane person? 

A. No, sir; they are about the same. 

Q. Then what reason is there why we should not relieve the 
feeble-minded institutions by taking the adult physical insane and 
putting them in insane asylums and drawing the line at 25 or 30 
years of age? 

A. Well, I was only thinking of the fact that the present asylums 
are very much crowded and the crowd would interfere with their 
treatment of the acute insane and it would be detrimental to both. 
I think if you would establish plenty of room for the chronic in- 
sane then it would be very good to get them out of these institutions 
for feeble-minded children. 

Q. Suppose we would establish small asylums for the acute in- 
sane, separating them from the chronic insane and feeble-minded, 
say three small asylums for the acute insane and provide additional 
capacity for the chronic insane and then treat the feeble-minded 
separate and alone, wouldn't that be the best plan? 

A. It would work to the benefit of the improvable children in our 
institution. 

Q. (By Mr. Hall.) After what age do you consider a feeble-minded 
person unimprovable? 

A. A child that has not any instruction before he is twenty years 
of age will never improve very much. His brain becomes less plastic 
and less susceptible to impressions. 

Q. Then a man brought. here at twenty-five years of age would 
not be improvable? 

A. No, sir. 



202 

Q. Why wouldn't it be better to have some place for them where 
they could be treated separately? 

A. Why multiply institutions, why not increase the capacity of 
those already established? In that way we get a better classifica- 
tion and they can be useful on the ground, they can shovel coal, make 
roads and do other work necessary in and around the buildings and 
grounds. 

Q. Your schools and all those things and these ladies teaching, 
that we saw to-day, is all intended to improve them some? 

A. Yes, sir. 

Q. After they get past that stage and stay here what should be 
done with them? 

A. They ought to be got out of the school department. 

Q. If you have another department wouldn't it be better? 

A. Yes, sir. 

Q. And have th^m segregated from the others? 

A. Yes, sir. 

Q. (By Mr. Bliss.) Isn't there a very strong pressure brougnt 
to bear upon you for the admission of children who are improvable 
whom you cannot admit because of lack of room? 

A. Yes, sir. 

Q. Wouldn't it be to their benefit if these unimprovable adults 
should be sent away, no matter where, to insane asylums or some- 
where else, to make room in your institution for the improvable 
cases? 

A. They should be sent out of our training department, at least. 

Q. Does it make any difference whether sent out of your training 
department, or to some other institution? 

A. No, sir; except there should be a custodial department where 
these unimprovable and able bodied men could be utilized; the} 
could be utilized on the farm. 

Q. It is simply a question of economy in your mind? 

A. Yes, sir. 

Q. You don't think that ought to be a controlling influence in 
passing legislation on a subject of this kind? 

A. Indeed I do; I think it is very important to be considered, not 
to sacrifice anything but to give them the best treatment possible 
and do it with the lowest expense. I don't think economy should 
come first but I think it should be taken into consideration. 1 
think having a training school for the improvable children, a custo- 
dial department for the unimprovable and asylums for the helpless 
would be to the best interest of all concerned. We have the older 
unimprovable mothers that act as mothers to the helpless children; 
they form an attachment for them and do not feel any repulsion 



203 

towards them and their work is very valuable in our institution. 
You saw one of that character in one of our rooms to-day. 

Q. But anybody who can work and earn their own living could 
do the same thing that they do here in the insane asylum? 

A. In the case of this woman, if we would send these adult women 
away to insane asylums we could not hire women to do the same 
tbrnu that they do here. 

Q. And they could do nothing in the insane asylum? 

A. They couldn't do anything to compare with the importance 
of tbe work they do here. 

Q. (By Mr. Snyder.) And the expense would be more to the insti- 
tution? 

A. Yes, sir. 

Q. What is your judgment about county institutions and as a 
rule do they have as many advantages to treat these feeble-minded 
as in an institution like this? 

A 1 don't think a county institution has an opportunity at all 
to tram feeble-minded children. 

Q. (By Mr. Hall.) Are any taken from here to the county institu- 
tions? 

A. Some of our adult able bodied ones are taken to the county in- 
stitutions. 

Q, (By Mr. Snyder.) Generally cases that are incurable? 

A. Usually those who have passed through the training age and 
useful in work and as useful in the county institutions as they can 
be here. 

Q. (By Mr. Hall.) Feeble-mindedness is an incurable condition? 

A. Yes, sir. 

Q. What you said about cures had reference to epilepsy? 

A. We get some children who are not feeble-minded but w 7 ho are 
backward and are feeble-minded through lack of certain develop- 
ment or certain diseases. They are not feeble-minded but appar- 
ently so; their minds are undeveloped. 

Q. (By Mr. Snyder.) What amendment would you suggest to our 
present laws in order to better an institution of this kind? 

A. I know of nothing except it be in the w 7 ay of appropriations 
to increase the work. 

Q. So as to give you capacity enough to grade your different de- 
partments? 

A. Yes, sir; for these adult ones who have passed through the 
school age and who are past the school age at the time of admission 
and those helpless ones who are incapable of instruction. These 
buildings are very well adapted for these improvable children but 
after they pass through seven years, it takes seven years in our 



204 

course, then there should be some way where they could go out, 
either to some county institution or hospital for the insane, or my 
preference would be a custodial department where they could be 
drawn on for help in the various departments of the institution, 
and I think we should have a farm building where the big able- 
bodied boys could work on the farm, a building near the barn; they 
don't require so much hospital care and don't care for children and 
would be happier if they did not have to have the same restraint 
that they have to have in the school department. 

Q. Say counties that would be grouped or sub-divided like judi- 
cial districts, say if three, four or five small counties would go 
together and have an institution for both the insane and feeble- 
minded where an institution would afford a school something similar 
to an institution of this kind and because of its nearness would 
afford to parents an opportunity to visit their children frequently, 
do you consider that would be of some advantage? 

A. The same sized district which would supply inmates enough 
to establish a hospital for the insane would not supply enough imbe- 
ciles to establish an institution, making the district three or four 
hundred' thousand, or three hundred thousand population. 

Q. Take one in six hundred thousand and make the district so 
there would be a couple hundred where they could afford to have 
some instructors, do you think that would be much advantage where 
the parents could visit them frequently, or more convenient for the 
parent to visit the institution? 

A. I don't know whether that is advisable; too frequent visits 
we don't think is a good thing. 

Q. It would upset them if there were too frequent visits? 

A. It upsets them and upsets the parents too. 

Q. What percentage of the parents visit their children here where 
they are living near? 

A. Well, we have a great many visitors. 

Q. Do you suppose 75 per cent.? 

A. I suppose 75 per cent, of the visitors get here sometime during 
the year. 

Q. (By Mr. Bliss.) Supposing such institutions were established 
in some places under the control of the State and be under the uni- 
form control of some one person, don't you think a larger number 
of such institutions, close to the homes of the patients and accom- 
modating a much larger number of patients, would be better, con- 
sidering it in the light of what is for the best interest of the patient 
and leaving the question of economy out? 

A. I think you get better results, considering it for the best in- 
terest of the patient, under proper classification and system, in 



205 

having a large number together than you do in a lot of small insti- 
tutions, particularly in the case of the feeble-minded. 

Q. Would you also apply that to the chronic insane? 

A. I think it applies particularly to the feeble-minded; my experi- 
ence is not as great, however, in that direction. 

Q. That is, improvable cases? 

A. No, sir; all classes. 

Q. What is the cost per capita as compared with the State insane 
asylums? 

A. A little less. 

Q. Is that due to the employment of many of the able-bodied 
adult imbeciles? 

A. Yes, sir; and from the fact that we do not require as many 
attendants. We employ a corps of teachers, which is quite an ex- 
pense, that they do not have in a hospital for the insane. 

Q. How many patients do you have to an attendant? 

A. About twenty-five and in the insane asylums it runs one to 
ten. We have thirty-six attendants, twelve of whom are men. 

Q. Do you have teachers in addition to these attendants? 

A. Yes, sir. 

Q. How many patients do you give to a teacher? 

A. A teacher has twenty-five to thirty pupils. 

Q. So that if the able-bodied adults were taken out of this insti- 
tution and put into the insane State or county institutions your 
cost would be increased and would be increased on account of the 
loss of the labor of these people? 

A. Yes, sir; ours would be considerably increased. I don't know 
how much theirs would be decreased. I believe they are more 
valuable to us than to the insane asylums because we can supply 
them with work. 

Q. Does the same rule apply to Wernersville, that the cost per 
capita is less than at other institutions because their inmates can 
be utilized for work? 

A. Yes, sir. 

Q. (By Mr. Snyder.) I think you stated what the cost per capita 
was before, what was it? 

A. One hundred and eighty-two dollars a year. 

Q. That would be about what per week? 

A. Three dollars and fifty cents a week. The average runs in the 
insane hospital about $3.75 to $4.00 and some of them more than 
that. 

Q. If you had two thousand patients your cost per capita would 
be considerably less? 

A. 1 believe if we had facilities so as to train the younger chil- 



206 

dren to be useful, that in time the population would increase to 
fifteen hundred and 1 am sure the per capita would be very much 
less than it is now. 

Q. It would make it about one-third less or twenty-five per cent, 
less? 

A. I don't see any reason why the per capita could not be reduced 
to $125, at least, a year. 

Q. (By Mr. Hall.) Of course the food and clothing would remain 
about the same? 

A. Well, in reference to the food we calculate to raise more of it 
here with increased facilities. 

Q. It would be included in what you would get in increased 
returns because of increased facilities. How long has this insti- 
tution been running? 

A. Five years. 

Q. What is the length of your course? 

A. Seven years. 

Q. You have not graduated any one yet? 

A. No, sir; some children, however, have come in where it was not 
necessary to start them at the bottom. 

Q. You have not had time to educate a corps of people whom you 
think could be made very useful but in ten years there may be 
some? 

A. In ten years from now I think they would be very efficient. 

Q. That would have a great tendency to decrease the cost per 
capita? 

A. Yes, sir. 

Q. (By Mr. Bliss.) How much would have to be invested to in- 
crease the capacity of this institution in order to accommodate fif- 
teen hundred inmates? 

A. We calculate that we could put up custodial buildings for 320 
pupils for about $300,000. 

Q. That would increase your capacity to about 1,100? 

A. Yes, that would increase our capacity to about 1,100. 

Q. (By Mr. McClain). I noticed in the dining room at noon and at 
supper time a young lady waited on our table, wearing a gold watch, 
what kind of a malady is she suffering with, is she feeble-minded? 

A. Yes, sir; she is hysterical. She has the lack of self control 
and afflicted with irresponsibility; at home, she will not stay at 
home; she will wander out on the streets and solicit men. 

Q. How long has she been here? 

A. She has been here about three years. 

Q. She looked bright and from her appearance one would think 
there was nothing wrong with her? 



207 

A. That is the trouble with her. 

Q. (By Mr. Bliss.) How old is she? 

A. About twenty-two years old. 

Q. Don't you think she is more fitted for the insane asylum than 
an institution like this? 

A. No, sir; it is simply a case of imbecility; she is not insane, she 
is only w r eak-minded. 

Q. What is the difference between that kind of imbecility and 
insanity, technically? 

A. She lacks self control but never had any delusion or halluci- 
nations and no disease. 

Q. Has she natural reasoning capacity? 

A. No, sir. 

Q. Why isn't she insane then, what is an insane man in your 
judgment? 

A. You ask some of the superintendents of the hospitals for the 
insane about that. 

Q. Is her mind in a condition of arrested development, isn't she 
bright? 

A. No, sir; she is not bright. She has not the power to tell the 
truth. 

Q. Can she distinguish between right and wrong? 

A. No, sir; I don't think so. 

Q. Or reason? 

A. Her reasoning powers are very limited but those are not 
symptoms of insanity. 

Q. What are? 

A. Delusions and hallucinations, where you imagine things are 
so that are not so. 

Q. Then you have out here in the institution a boy who imagines 
he is the handsomest man in the world, when the contrary is very 
much in evidence, isn't he rather insane than feeble-minded? 

A. I don't think so. 

Q. (By Mr. Hall.) . There never was a time when he knew he was 
not the handsomest man in the world? 

A. I suppose not. 

Q. (By Mr. Snyder.) Isn't it a fact that an insane person may 
have a well developed brain on every subject except one and on that 
one particular thing he may have his delusions? 

A. Yes, sir. 

Q. A feeble-minded person cannot reason well on any particular 
subject? 

A. In the case of a feeble-minded child the feeblemindedness 
may be pretty clever in some directions, The difference is, that 



208 

an insane person lias lost some mental power which they once 
possessed, while a feeble-minded person has never developed into 
a normal person. 

Q. Then an imbecile is one who lacks some faculty when he is 
born and an insane person is one who has been born with full 
capacity and afterwards loses some mental power? 

A. Yes, sir. 

Q. And do you make any distinction in the method of treatment? 

A. Yes, sir; where something is lost it shows there is some dis- 
ease, or process or disturbance, deteriorating the mental cells which 
are there, while in the feeble-minded person the cells have not been 
developed. In the one case you try to build up the cells and in 
the other case you try to restore them. 

Q. (By Mr. Hall.) In the room where they were making mattresses 
there was a boy making brooms, a very bright looking boy and I 
thought he was an employe but I was told he was an inmate and 
that he had no moral sense? 

A. He is a boy who never would go to school, who was incorrigible 
and never obeyed his parents. He is a boy whom I think will de- 
velop. I think it is only because he was not properly trained and 
given proper advantages and it would certainly not be well to turn 
him out in the world. 

Q. There are points in which he is not deficient? 

A. He seems to be coming out all right, although he lacks moral 
sense? 

Q. Is he deficient, mentally, at all? 

A. That is a mental deficiency. 

Q. Do you think that all persons who lack moral sense ought to 
be in feeble-minded institutions, or inside of a jail? 

A. No, sir; not in jails but I think every person who will not 
go to school and knows nothing about moral restraint should be 
placed where he will be made to obey. 

Q. Is there any difference between that boy and the boys who 
are sent every year to the House of Refuge for incorrigibility? 

A. No, sir; he is just such a boy that might be sent there. 

Q. Isn't there danger in putting such a boy with boys who are 
mentally defective in lessening his mental capacity? 

A. No, sir; not a bit. 

Q. You don't think that the association of one boy, who is morally 
deficient and has no mental defect, with boys who are mentally 
defective is not injurious to him? 

A. No, sir; it might be the other way. I think any acquired bad 
habits, such as masturbation or using tobacco, he may teach imbe- 
ciles who are very ready to take up such things. 



209 

Q. (By Mr. Snyder.) Does he attempt to teach other boys his 
weakness? 

A. No, sir; that boy, under our regulations, gets along very sat- 
isfactorily? 

Q. His weakness does not manifest itself to his associates? 

A. No, sir. 

Q. He does not practice them in the presence of or teach them 
to his associates? 

A. I have not observed that. 

Q. (By Mr. Hall.) What is the disease from which these small 
children suffer and what are they called? 

A. Cretins. It is due to the development of the glands, the 
fibroid glands. If you take them at young enough period you can 
develop them. Take the glands of sheep and dry them and make 
them into tablets and thus form a fibroid extract. This gland se- 
cretes the substance which is essential to the proper growth in 
them. 

Q. (By Mr. Heidelbaugh.) Are those two small persons relatives? 

A. No, sir; one is from Wilkes-Barre and one from Clarion county. 
It is a very rare thing; I only know of one other in Pennsylvania. 

Q. How tall is that little woman? 

A. My recollection is about thirty inches. 

Q. (By Mr. Hall.) That growth leads to mental deficiency? 

A. Yes, sir; this condition of Cretinism is very common in some 
countries, especially in Switzerland, particularly in the mountains 
and valleys w T here they get little sunlight. 

Q. Goitre is very common also? 

A. Yes, sir. 

The investigation ended at this point. Subsequently Dr. Murdoch 
presented to the Commission the following paper: 

To the Legislative Commission to Investigate the Condition of 

State Institution for Feeble-Minded, 

Polk, Pa. 

Gentlemen: In accordance with your request for a statement of 
the present condition and suggestions in regard to desirable changes 
in the State Institution for Feeble-Minded of Western Pennsylvania, 
I present the following facts: 

The Institution for Feeble-Minded of Western Pennsylvania is 
located at Polk, Venango county, six miles from Franklin, on a 
tract of 870 acres. The greater portion of the land is tillable and 

14 



210 

suitable for agricultural pursuits. There is an abundance of excel- 
lent water, obtained from springs, the water flowing to the buildings 
by gravity. The drainage is good. The location is reasonably ac- 
cessible, and still sufficiently remote from a populous centre to 
allow the inmates to engage freely in out door pursuits without 
coming in contact with the idle curious. The location is an ideal 
one for an institution for the feeble-minded. 

The institution is a school and an industrial colony where the 
young and improvable, aside from the rudiments of a common school 
education, are taught farming and gardening, stock raising, aad 
a variety of occupations suited to their mental capacity and apti- 
tudes. All who are physically able aid in carrying on the work of 
the institution, on the farm, in the shops, sewing rooms, laundry 
and kitchen. 

The buildings upon the premises are in good repair and, for their 
limited capacity, are admirably adapted to the care of the class 
of the feeble-minded for which they were originally intended, which 
is that class of children susceptible of improvement in a training 
school for feeble-minded children. 

Institutions for the feeble-minded require two distinct depart- 
ments, an educational and a custodial. The unimproved, the help- 
less, the epileptic and the paralytic require custodial buildings 
specially constructed for their peculiar requirements. Two hundred 
and fifty of the children now cared for in the institution, and a large 
number for whose admission application has been made, are not 
susceptible of improvement but require the most careful care and 
attention; these are totally unsuited for the educational depart- 
ment which, as has been stated, is the only department of the insti- 
tution as yet constructed. The care of this class of helpless ones 
in the training department is at great inconvenience and at a much 
higher per capita cost than it would be were we provided with 
appropriate accommodation for this unfortunate class. 

The rated capacity of the institution is 600. 

The number present April 30, 1902, was 815. 

Applications for admission on file April 30, 1902, 120. 

The 215 inmates above the rated capacity of the institution are 
being cared for temporarily by the conversion of day rooms, school 
rooms and shops into dormitories, and store rooms into dining 
rooms, to the great inconvenience of the schools and the industrial 
department, and in fact the entire institution. 

Public sentiment demands that the State provide for all the 
feeble-minded, whose presence in families and communities is a per- 
petual source of danger and injury. Many unfortunate individuals 
of this character, who are at present left to wander about as the 



211 

butt of ridicule and thoughtless sport, or the victims of lust, if 
provided a home within the institution, would live happy and con- 
tented lives and be more or less productive without becoming the 
irresponsible progenitors of a miserable posterity. Henderson, in 
his book on "Dependents, Defectives and Delinquents," says: "There 
is general agreement among authorities that there is no trait, phy- 
sical or mental, which is so likely to be inherited as feeble-minded- 
ness. The defective child injures the family to which it belongs; 
if it is kept at home it is a source of constant humiliation, annoy- 
ance, often of physical danger, loss of time and energy, the weak- 
ness of the mother, and vicious example to other children." 

The following examples, taken from applications for admission, 
are but a few of hundreds of cases : 

In one family there are four children. The eldest, a boy of nine 
years, is perfectly helpless and devoid of all intelligence. The sec- 
ond child, aged six years, is strong enough in body but is idiotic and 
at this early age has developed homicidal tendencies, smashes every- 
thing breakable within reach, has to be carefully watched lest he 
inflict personal injury on the other children, and when corrected 
will savagely endeavor to bite. He is completely devoid of the sense 
of fear, strives to catch every passing horse by the tail; in conse- 
quence he is kept tied hand and foot the greater part of the time. 
The third, a girl of three years, is a perfect idiot and as helpless as 
a babe. Th fourth is a mere babe, too young to have its future 
prognosticated. All are microcephalic, i. e., have very small heads, 
with receding foreheads. The mother, with a poor nervous organi- 
zation at best, is completely worn out with the care of her childreu 
and is a chronic invalid. The father, a laborer, and who is himself 
mentally deficient, is unable to seek work as he has to stay at home 
to care for his miserable progeny. They are dependent upon their 
neighbors for support. 

A widow, whose husband was insane, has two feeble-minded chil- 
dren, a boy aged twenty-three and a girl aged twenty. She is com- 
pelled to care for her defective offspring alone as no one can be 
induced to live with her on account of the filthy habits of the chil- 
dren. She earns her livelihood as a washerwoman and when col- 
lecting or delivering clothing leaves her irresponsible children to 
their own devices, with the result that the girl, a most repulsive 
paralytic, gave birth to a child which will, no doubt, inherit the 
defects of its parents. 

Another widow with a feeble-minded son tries to earn a living 
by keeping boarders, keeping her feeble-minded boy in seclusion. 
The child's queer noises lead to his discovery by the boarders, who 
cannot be induced to remain unless the child is taken away. 

Another irresponsible girl of fourteen years is the victim of the 



212 

lust of a band of unprincipled young men and boys in the neigh- 
borhood of her home. 

These few eases suffice to shovr the necessity of providing ample 
accommodations for all of this class of unfortunates where they may 
be protected from the cruel taunts and ridicules of the thoughtless, 
and the vices of the unprincipled: thus, at the same time, protecting 
the feeble one. lifting an awful load from the other members of the 
family, protecting society from a constant source of danger and 
posterity from the care of a miserable progeny. 

Section 10 of the act creating the institution, contains the follow- 
ing: "That this institution shall be so planned in the beginning 
and constructed as shall provide separate classification of the nu- 
merous groups embraced under the terms idiotic and imbecile or 
feeble-minded.''' 

The building commission in endeavoring to carry out the pro- 
visions of the act prepared most excellent plans: a training school 
for the improvable and custodial buildings for the unimprovable. 
The funds available were not sufficient to carry out the plans, the 
training school only being constructed. This is most admirably 
adapted for the educational department, for the children capable 
of improvement under instruction and who are self helpful to a 
degree, but is totally unsuited for the unimprovable, the helpless. 
the low grade, the paralytic and the epileptic. This latter class, 
however, appeals strongly to our sympathies and we have owing to 
most urgent appeals, received many of this class, notwithstanding 
the fact that their care has been at a great expense and inconveni- 
ence, which can only be avoided by the construction of suitable 
custodial buildings. 

The great need of these buildings has been presented by the 
Board of Public Charities and by the board of trustees of the insti- 
tution at the past four sessions of the Legislature. Twice appro- 
priations for their construction have passed both branches of the 
Legislature but have failed to receive the Governor's sanction. 

We have most excellent plans for these buildings. While their 
need has been felt for years it has continued to grow more pressing: 
it is now imperative. We sincerely trust funds for their construc- 
tion will be provided by the Legislature at its next session, in order 
that the institution may be relieved of its overcrowded condition 
and be able to extend aid to the unfortunate feeble-minded without 
for whom, as yet, no adeojiate provision has been made. 

Other buildings contemplated in the original plans should be 
provided. These include an assembly hall and an industrial school 
for girls. 

We most earnestly appeal to your honorable committee for aid 



213 

in relieving us of our present distress, caused by the crowding of the 
institution and the caring for unimprovable and helpless children 
without proper conveniences. We also bespeak your aid in our en- 
deavor to obtain an appropriation to properly provide for the many 
worthy feeble-minded ones who cannot be admitted into the insti- 
tution until additional and appropriate accommodations have been 
provided. 

Kespectfully submitted, 

J. M. MURDOCH, M. D., 
Superintendent. 




(314) 



LEGISLATIVE COMMISSION TO INQUIKE INTO 
THE CONDITION OF PENNSYLVANIA INSANE. 



Inspection of the State Hospital 
for^the Insane, Warren, Penna. 



MAY 26th, 1902 



(215) 




w?m& 






7m@fc 




(216) 




H 



ft 
o 

sn 



INSPECTION OF THE STATE HOSPITALS FOR THE INSANE, 
WARREN, PA., MAY 26, 1902. 



The Commission arrived in Warren on the night of the 26th of 
May, 1902, and in the forenoon of the next day paid an official visit 
to the Warren hospital. 

Dr. Morris S. Guth, superintendent; J. W. Greenland, steward, 
together with Messrs. C. F. Shirk, of Erie; R. B. Stone, of Bradford, 
and O. C. Allen, of W r arren, members of the board of trustees, 
accompanied the Commission during its inspection of the hospital. 
Each ward was visited and an inspection made of the dining rooms, 
lavatories and the rooms occupied by the inmates. The fire escapes 
were also examined as well as the ventilating system; also the 
wards, both in the male and female departments, including the 
sleeping apartments, bath rooms, libraries, sewing rooms and art 
buildings for women, in which many articles were seen modelled 
in clay by patients. The training school for attendants was also 
visited. It was stated that there were about eighty epileptics in 
the institution. In one of the parlors of the female wards a lady 
patient was seen playing an organ accompanied by another singing. 

The institution was found to be in a crowded condition, beds in 
some instances being placed in rooms intended for dining rooms 
and in other instances in the corridors. All classes of patients were 
visited, including those wards in which the most violent and the 
worst cases were confined. 

After inspecting the hospital proper the Commission was driven 
in carriages to the Colony farm, a mile or two below the main build- 
ing. Here certain chronic cases, who are employed for such work 
as is suitable for them, are kept during the period in which they 
are at work on the farm and in the extensive grading of the grounds 
about the new building. A visit was paid to Hygeia Hall, a build- 
ing used for convalescents; it appeared to be very comfortable, 
cheerful and homelike but of somewhat limited capacity. There 
were fifteen convalescents occupying the building at the time. A 
visit was then made to the home for the female nurses recently 
constructed. It is an important adjunct to the usefulness of the 
institution from the fact that during the hours in which the nurses 
are relieved from their duties they are taken away from the sight 
and society of their charges. The Commission also vis ted Chapel 
Hall, where all religious exercises are held; also the theatre room 

(217) 



218 

especially provided for amusements and entertainments; also the 
Turkish bath room established for both male and female patients 
(being separate). The laundries and kitchens were also inspected. 

It was stated that the farm consisted of about 700 acres of land, 
about 300 of which were under cultivation. There are 106 cows 
and 18 horses kept in connection with the institution. 

The tour of inspection closed with a visit to the stables in connec- 
tion with a hennery, milk house, and a piggery located near by. 

At a formal meeting held by the Commission (after the inspection) 
the following proceedings took place in the office of Dr. Guth. 

Dr. M. S. Guth, superintendent, testifies as follows: 

Q. (By Mr, Snyder, Chairman.) How many epileptics have you in 
the institution? 

A. I think we have about eighty or ninety; I think that would 
cover the number. 

Q. Would there be any advantage in having them kept in a sepa- 
rate ward or separate building? 

A. Yes, sir; I think it would be an advantage to have them by 
themselves. We do that as much as we possibly can here. 

Q. What is the history of the epileptics, as a rule, has the parent 
been insane on the one side or the other? 

A. Yes, it is hereditary as a rule. 

Q. The percentages of cures are very small? 

A. Very small, almost hopeless. 

Q. Except where there has been an accident and it is due to an 
operation to relieve them? 

A. That would be exceptional. 

Q. In that class of cases there are not many where the trouble 
comes from an accident? 

A. No, very few that come from any traumatic causes. 

Mr. Snyder. Has any member of the Commission any questions 
to ask the doctor? 

Q. (By Mr. Hall.) Is there any system of sub-division that you 
would recommend here? 

A. You mean in this institution? 

Q. Yes, sir; additional facilities so the patients could be divided 
into classes? 

A. Well, we do that as much as we can. 

Q. Are you able to do it as much as should be done? 

A. No, sir; we cannot on account of the crowded condition of the 
institution. 

Q. In what way would you suggest the acquirement of greater 
facilities? 

A. By building additional buildings. 



219 

Q. You would put in those certain cases? 

A. Yes, sir; take out the epileptics, for instance, and separate 
them like we do in the chronic cases at the Colony farm and estab- 
lish a place for the men convalescents. We have no place for the 
men now. 

Q. Would you take the younger patients away from the older 

ones? 

A. I think I would, I think that would be an advantage. 

Q. You have classifications up here in a female ward where their 
hair is cut short and they are wearing long gowns, they seem to 
be very bad patients, would you have a separate place for them? 

A. Yes, sir; undoubtedly we would. We do classify those as 
much as we can. 

Q. There were some of those among the others? 

A. Yes, they were in the back sections, in the back wards; I 
would keep those separate as much as possible. 

Q. Are not some of those women troubled with a desire for sexual 
intercourse, or afflicted with nymphomania? 

A. With some it is more so than others. 

Q. What other women are there who were not bad in that respect, 
is it not a common thing? 

A. No, it is not a common thing but still there are a number of 
cases of that kind. 

Q. What I have understood here about patients is the fact that 
because they are insane does not render them indifferent upon cer- 
tain things, they might object to realizing that they are kept with 
other insane people, take a woman who is insane, but a modest 
woman, and thrown into classes of that kind, would it not affect 
her? 

A. Yes, sir; I think it would, that would depend upon what her 
mental state was. I would state that all these people represent 
different grades of society but the large majority of. them come 
from the middle classes and while they would resent that, they 
would at the same time have a feeling of sympathy for them and 
would recognize to a certain extent that it was disease that made 
them so because that is the fact. 

Q. Do you notice many women who have been fairly well brought 
up and after coming here break out into the use of profanity? 

A. Yes, sir; very apt to. 

Q. A woman who would not do such a thing at home would be 
very apt to do it here? 

A. Yes, sir; it is just the opposite state to her normal state. It 
is very often the case that she will do so. 

Q. I was speaking about it at the table. To classify you think 



220 

it would be better to do that by adding to the larger institutions? 

A. Yes, sir; as far as possible. 

Q. To put people who are nearly alike with each other? 

A. Yes, sir. 

Q. You think that is better? 

A. Yes, sir; I do. 

Q. (By Mr. Bliss.) If we should take away the epileptics and place 
them in another asylum established for that character of cases 
alone and take away the acute insane and transfer them to another 
asylum, how much would that relieve you here? 

A. That would give a great deal of relief but I don't see what 
you would do with the acute cases. 

Q. Would that enable you to classify them with more benefit 
to those who remain? 

A. Yes, sir; it would. While I think the epileptics should be 
taken away and kept separately, but I don't think it would be an 
advantage to take away the acute cases. 

Q. Where would you put them? 

A. Into the excited wards and give them such individual and 
special treatment as their case demands. 

Q. (By Mr. Hall.) If you had a separate apartment simply for the 
acute couldn't you treat them better? 

A. Yes, sir; we could but I think you would find that it would 
be very expensive. That is what I said about Dr. Peterson's posi- 
tion in New York; he thinks there ought to be hospitals for the acute 
cases and while I think it is an ideal plan I don't think it can be 
carried out. 

Q. (By Mr. Bliss.) Why ideal? 

A. Because you can give them more individual care and have a 
larger percentage of cures but I don't think the State would do it. 

Q. That is what we are trying to get at through you experts. 
Would that relieve you with your present facilities and enable you 
to classify and properly classify the chronic that would be left? 

A. Yes, sir. 

Q. And if this is not done would it be a benefit to erect one or 
two-story buildings, not according to the architecture of the present 
buildings here, so you can separate them, could that be done? 

A. Yes, sir; that was the position I took before you in Philadel- 
phia. That would be part of the plan to relieve the over crowded 
condition, that is, to build a few buildings surrounding the present 
plants. I think to do this would be a great deal cheaper and we 
could care for the acute in a separate building entirely disconnected 
but under the same management. 

Q. Have you any idea how much it would cost to accommodate 




:r. 



z?. 



221 

the present number of acute cases and also accommodations for the 
present number of epileptics? 

A. No, sir. 

Q. (By Mr. Hall.) Do you think it would be a good thing to have 
a separate building added to our present hospitals, I mean adding 
to the general hospitals and relieve the present crowded condition 
of the hospitals from their care? 

A. Yes, sir. 

Q. Because they are a class that are distinct? 

A. Yes, sir; if there is much disturbance, mental disturbance, 
sometimes there is before and sometimes after an attack 
and they could be corrected accordingly. I have not given 
the matter any thought with reference to the expense of buildings 
of that kind but they need not be expensive buildings; I think a 
building such as the Colony building would be a great relief to 
our building here; they would only cost about |3,500. 

Q. (By Mr. Bliss.) What is the difference between a feeble-minded 
person and an insane person? 

A. I believe that is usually expressed like this, that mental 
alienation is feeble-mindedness or comes under the term of imbecility 
or idiocy; an idiot is where there has been no intelligence; imbecility 
is where there is an arrest of intelligence but both come under 
the head of mental alienation. Now you can add to that by adding 
insanity through becoming extra nervous or excited, as I pointed 
out to you this morning, that those who have originally been weak 
minded and have a bad heredity (although not necessarily insane) 
may from some cause or other have their mental balance overcome 
and become violent. 

Q. Have you any patients who were born in their present con- 
dition? 

A. You mean weak minded? 

Q. Yes, sir. 

A. Yes, sir. 

Q. (By Mr. Hall.) There is never anybody born insane? 

A. No, sir. 

Q. Insanity presupposes feeble-mindedness of some kind? 

A. Yes, sir; they can be born feeble-minded, or idiots, and then 
they can become insane afterwards but not born insane. 

Q. (By Mr. Bliss.) Thpn your distinction is that there is a mental 
balance, aH hough a weak feeble mind, while in the case of insanity 
there is an unbalanced condition? 

A. Yes, sir; unbalanced condition of that weakened state that 
existed. 

Q. Suppose the mind is strong and becomes unbalanced, that 



222 

would be insanity; a fully developed mind but weak mind, that 
would be imbecility and if it becomes unbalanced it becomes in- 
sanity? 

A. Yes, sir; that is it exactly. 

Q. Is it possible to fix the period of life, or the stage of develop- 
ment in an imbecile condition, or one who is weak-minded, at which 
he ought to be put in an insane asylum? 

A. No, sir. 

Q. But you would keep them for life in a special institution pro- 
vided for that class of cases? 

A. I think so. 

Q. (By Mr. Hall.) For example, there are some feeble-minded 
people at Polk who are forty years old, there is no chance for im- 
provement in such cases? 

A. No, sir. 

Q. Would you keep them there or commit them to an insane 
asylum ? 

A. That is a very delicate subject. I don't believe Polk is the 
proper place for them or a hospital for the insane is the proper 
place, because those people usually have pretty bad habits and they 
are communicated to the newcomers and I think of the two places 
the hospital for the insane would be the best place. While not truly 
insane they are alienated and never can be anything else. 

Q. (By Mr. Hall.) Possibly after the age of twenty, or something 
like that, there is no improvement, or much improvement? 

A. No, sir. 

Q. Then isn't it sort of wasting a proper home for the feeble- 
minded children to keep persons there from thirty to forty years 
of age and should they not be taken somewhere else and devote 
the room to the improvable children there during the seven years 
course that they have in that institution? 

A. I think so; I always felt that was a mistake but I think that 
the law originating Polk has made it so, The construction was 
that the institution was intended for the feeble-minded and it was 
not necessarily children but a person once feeble-minded was always 
feeble-minded; it seems to me, however, as you say, they ought not 
to be maintained there at this certain period. That is, when they 
become unimprovable, after a certain age they cannot be cured and 
ought not to be maintained there. 

Q. (By Mr. Bliss.) Suppose you look at it from another point of 
view. Very many of them in that condition are able to work and 
work with considerable intelligence and on account of their work 
relieve the institution of considerable expense, would they be as 
useful in your institution as they are there? 



223 

A. I think so. 

Q. (By Mr. Hall.) Do you always have all the laborers among 
your patients that you can use? 

A. No, sir. 

Q. What percentage of your patients can you employ at work? 

A. We have possibly half the number of our patients at work 
at something or other but it does not amount to as much as the 
work of an ordinary laborer. 

Q. Certainly not for the reason that you do not keep them en- 
gaged and working constantly? 

A. No, sir. 

Q. The women do not do so much as the men? 

A. No, sir. 

Q. (By Mr. Snyder.) Suppose the cost for buildings and mainte- 
nance were not taken into consideration, only what would produce 
the most comfort and the greatest number of cures for the insane, 
what would you suggest as a change in our present laws or in the 
management of the institutions under our laws, that is, don't take 
into consideration the cost but what would be for the most comfort 
and best interest of the patient? 

A. I would say hospitals for the acute insane would be the thing 
and have the epileptic by themselves and criminals by themselves 
and the rest by themselves. 

Q. In separate hospitals? 

A. Yes, sir. 

Q. Would that bring about the most comfort for the patients and 
produce the most cures? 

A. Yes, sir. 

Q. (By Mr. Marshall.) You mean in separate buildings but under 
one management? 

A. Yes, sir. 

Q. (By Mr. Hall.) Increase the facilities by adding to the build- 
ings in those asylums where they are established? 

A. Yes, sir. 

Q. (By Mr. Snyder.) You would keep the criminal insane in one 
department? 

A. Yes, sir. 

Q. And epileptics in one department? 

A. Yes, sir. 

Q. And the acute insane in one department? 

A. Yes, sir. 

Q. And there may be two or three other grades? 

A. Yes, sir; except that I have always thought that for the crim- 
inal insane there should be a department in connection with the 
penitentiary for the convict insane. 

Q. How about the man with a mania? 



224 

\. He would naturally come into one of those institutions. 

Q. Not to an institution for the criminal insane? 

A. No, sir. 

Q. Where would you put the case of a man who threatened to 
kill. Take the case of the man who dug a grave in his cellar for 
the purpose of putting his wife after killing her, where would you 
put him, would you put him in the criminal wards? 

A. He has not committed a crime? 

Q. He was about to commit a crime and because his wife did not 
return he did not have the opportunity. You mean by convict, one 
who has committed crime and became insane afterwards? 

A. Yes, sir. 

Q. (By Mr. Bliss.) Suppose a man has committed crime and been 
acquitted on the ground of insanity how would you classify him, he 
has committed a crime but has been acquitted because of insanity? 

A. Well, I think he naturally belongs to the convicts. 

Q. What difference would there be between him and this man 
who dug the grave for his wife and would have put her there if 
she had come home? 

A. That is a pretty fine point. We have several men here who 
have committed crime and have been acquitted on the ground of 
insanity and they do very well. They have to be watched but they 
get along all right; it seems to me that that might possibly be a 
good way. There were several pointed out to-day in the Colony 
farm building. 

Q. (By Mr. Snyder.) Don't you think that a man who had prepared 
to commit a crime, such as this man of whom we are speaking, he 
dug a grave for his wife and although he did not commit the deed 
and evidently insane when he did that, wouldn't he be as fit a 
patient for a criminal ward as the man who had committed a crime 
when he was insane? 

A. Well, I think there is a difference there. 

Q. Of course, under the law, he would not be found guilty of com- 
mitting a crime, such as the other man committed, because he had 
not committed it but doubtless he would have committed it if his 
wife had returned? 

A. It might be a passing fancy; it might be a delusion, he could 
overcome that. Possibly that might be regarded in the way that 
many of these people act, which is upon impulse, and just as soon 
as they commit the act they are sorry for it. 

Q. (By Mr. Bliss.) Would you class him among the criminal in- 
sane? 

A. He had not been convicted of any crime. 

Q. (By Mr. Snyder.) In the one case he was tried before the court 
for the commission of a crime and acquitted on the ground of in- 




- 

— 
- 
- 



X 




if 

! 

- 



225 

sanity, and in the other case he intended to commit a crime but was 
not able to carry his intention into execution because his wife 
did not return? 

A. In the one case he w T as a convicted insane person. 

Q. (By Mr. Bliss.) Do you limit your definition of the criminal 
insane to those who have been guilty of a commission of a crime and 
acquitted on the ground of insanity? 

A. I mean the criminal insane that have been guilty of the crime 
but not tried; those who have been acquitted on account of in- 
sanity. 

Q. Let me ask you a question: Suppose we were to abolish 
the system established at Wernersville and send the chronic insane 
to the other State asylums and establish an asylum for the treatment 
of the acute insane and transfer the acute cases from all the present 
asylums to that one, or those asylums, and establish an asylum 
for the epileptics, would it be an improvement on the present system 
or not? 

A. I think not; I don't see how you could do that very well be- 
cause it would make it too far for the friends to visit patients and 
the friends do insist on seeing the acute cases. 

Q. Suppose you had three small ones scattered throughout the 
State? 

A. That might be better but it seems to me the plan I stated 
before, that if you had facilities in connection with the larger hos- 
pitals, increased facilities, it would be the better plan. 

Q. (By Mr. Snyder.) You think they should be kept under one 
management? 

A. Yes, sir. 

Q. (By Mr. Hall.) The administration expense is an important 
factor connected with the running of a hospital? 

A. Yes, sir. 

Q. You think it would be an expense, or more expensive, to 
establish three administrations which could be avoided by increas- 
ing the facilities of those already established and where one staff 
is already created? 

A. Yes, sir. 

Q. (By Mr. Marshall.) In addition to that you have the land on 
which you can add to the buildings already erected? 

A. Yes, sir. 

Q. (By Mr. Bliss.) Is the proportion of the patients in the other 
asylums about the seme as in this institution? 

A. Yes, sir; I think so. 

Q. How many have you— if you are sure they are curable you call 
them acute cases? 

15 



226 

A. Yes, sir; I think we have in the neighborhood of seventy-five. 

Q. And what is the total number in the hospital? 

A. One thousand and thirty. 

Q. (By Mr. Snyder.) Your capacity is about 750? 

A. About TOO. 

Q. Did we go over the matter of the cost of the maintenance of 
patients in your former testimony? 

A. Yes. sir. 

Q. And the causes of insanity? 

A. Yes, sir; I believe so. 

Q. (By Mr. Hall.) How long do cases last, usually, in the acute 
or curable state, of course it varies? 

A. Acute insanity is usually denned as lasting anywhere from 
two months to a year. 

Q. In the case of a person who is in here for a year, or a year 
and a half, you don't think as a rule there is much chance of his 
recovery ? 

A. I think the chances are very much against him but we have 
had a number in this hospital who have been in five and six years, 
and even ten years and have become improved, not entirely, but im- 
proved sufficiently to go out and be useful members of society. I 
have a woman now ready to go home who has been in this hospital 
between six and seven years. 

Q. Was that due to her physical condition, weakened condition? 

A. Yes, sir. 

Q. And as that became better her mind improved? 

A. Yes, sir. 

Q. (By Mr. McClain). If that woman had children would the in- 
sanity be transmitted to her offspring? 

A. Yes, sir; I think so. You mean if that woman was to have 
children? 

Q. Yes, sir; after she left the institution cured? 

A. It would not be a safe thing; I think she tends that way and 
I think she has been tending that way and I think her having chil- 
dren made her that way. 

Q. Any hereditary taint in her case? 

A. I am not sure about that. 

Q. (By Mr. Bliss.) If there was you would be very sure there 
would be? 

A. Yes, sir. 

Q. (By Mr. Heidelbaugh.) Are there very many women admitted 
during change of life? 

A. Yes, sir. 

Q. (By Mr. Snyder.) The percentage of cures in that case is more 
than half? 



227 

A. Yes, sir. 

Q. Some, of course, remain always the same but the percentage 
would be 50 or 60 per cent.? 

A. Yes, sir; I was asked recently about a case by a physician 
that he sent to me here and after satisfying myself with what I 
believed it to be, she just having commenced to be affected with 
lost consciousness, I imagined he was interested and after I gave 
my diagnosis he wrote to me and wanted to know what I thought 
about a person marrying who was in that state and I said under no 
circumstances; I said I had very decided views about it. 

Q. (Mr. Hall.) I don't understand your terms, but is it difficult 
to tell when a patient is cured? 

A. It is a difficult thing and we avail ourselves of the opportunity 
by giving those people a trial by leave of absence. The lunacy law 
gives us that right and we send them home for thirty days and keep 
them on trial and if they improved in that period and we hear from 
them to that effect we discharge them as cured. I think there is a 
certain something you can feel in people, that you can't explain, 
which leads you to believe that they are all right, or nearly as 
you can tell, but it is a difficult thing because oftentimes we have 
sent people away whom we thought were all right and they had to 
come back. 

Q. The diagnosis of mental condition and physical weakness are 
two different things? 

A. Yes, sir; the case of the young girl going around in dissipa- 
tion and attending parties and theatres and sleeping very little, 
those are what are called simple insanity, there is no hereditary 
insanity there and there is no w T ay to account for it except for the 
offence against the laws of health and they are usually prolonged 
cases. I had another girl who came here; she was an invalid for 
four years and she became troublesome and they thought they would 
like to have her taken to Hygeia Hall and she took acute insanity 
and they thought she would die and we brought her here. If she 
had been in Erie, where she belonged, and a consultation taken 
place among a half dozen physicians she would have been beyond 
hope probably by the time she got here but we had her here and we 
cured her and she is in New York to-day receiving instructions in 
organ lessons. I do not mean this as a reflection upon the physi- 
cians but because of the delays incident in such cases on account 
of examinations and all that. She is a very fine girl and is doing 
very well. By the time they reach us they are very much excited 
on account of these examinations. 

Q. (By Mr. Bliss.) Isn't that an argument in favor of having 
hospitals nearer the homes of acute cases? 



228 

A. Yes, sir; that would be an argument but take the other side 
of it and you can have them on the same grounds and in connection 
with the other hospitals. That woman should have been treated in 
any of the emergency hospitals if they understood it but it seems 
that just as soon as a person is a little delirious and manifests a 
violence they think they cannot do anything with them. 

Q. (By Mr. Hall.) That is, the regular practitioners do not at- 
tempt to treat them? 

A. Xo, sir. 

Q. All they do is to give them something to quiet their nervous 
system? 

A. Yes, sir. 

Q. (By Mr. Bliss.) Do you think any change in the marriage laws 
would in any way prevent insanity or have a tendency to reduce 
the number? 

A. I don't know how that can be done; that must be done outside. 
There must be some restrictions in our marriage laws. 

Q. What kind of restrictions would you suggest? 

A. A little more carefulness in the selection of the persons who 
get married; of course we have to register them. 

Q. Would it not be advisable to make it more difficult to get 
married? 

A. Y^es, sir; I think it ought to be made more difficult. 

Q. If there is a class of people who ought not to be married should 
it not be prevented by legislation? 

A. Y r es, sir; I think so. 

Mr. Shirk (a Trustee.) About two years ago a mother and her two 
daughters were committed to this institution and within a year 
a son of her's was also committed to this place, so that we have 
the mother and three children here. These people should not be 
permitted to marry because of the taint of insanity. I know noth- 
ing about the father. Another case I have in mind is a woman here 
who comes from a very nice family and she married and had a 
daughter. Shortly after that daughter was born that woman was 
brought here. The daughter grew up to be a young woman and 
a young man on the railroad paid attention to her and his friends 
came to him and said, "Don't marry her because her mother is at 
Warren." He married her and a year after they were married she 
was brought to Warren, after the birth of a child, and the mother 
is still in this institution. 

Q. (By Mr. Hall.) Suppose the Legislature of Pennsylvania would 
pass a law restricting and limiting it, even denning what people 
should marry and say. you shall not have a license under certain 
restrictions, does that end it? 



229 

A. That is the trouble; it is a difficult problem. 

Q. (Mr. Snyder.) How would you get over it if they would go to 
New Jersey and thus avoid the law in this State? 

Mr. Bliss. We would have to do as we do now, wait until they 
adopt our laws. 

Mr. Marshall. It will not be many years until there will be uni- 
formity in all those laws in all the States of the Union. 

Mr. Hall. It is my opinion if you make it a penal offence and put 
every person in jail who married improperly you would have to have 
a lot of jails. 

Q. (By Mr. Snyder.) Do you think insanity is increasing according 
to the population? 

A. No, sir; I don't think so, I think it is keeping just about apace. 

Q. (Mr. Hall.) You have a different class of patients here from 
those who are at Blockley? 

A. Do you think so; in what way? 

Q. Most of the patients there are city born and bred, or foreigners 
and of a lower type. 

A. Ours are from the farming districts; they are from the middle 
classes. 

Mr. Hall. The Blockley patients are more from the pauper classes 
and degraded. 

Mr. Snyder. I think Philadelphia sends a better class of patients 
to Norristown. 

Dr. Guth. How do they discriminate? 

Mr. Snyder. Persons who are interested in having them committed 
get two physicians to certify that the party is insane and a petition 
is presented to court and the court acts on the petition and if they 
think the physicians are reputable the person is taken to the Nor- 
ristown asylum and Blockley has nothing to do with it. 

Mr. Hall. There is a large element of pauper insane there who 
come from the pauper class. I saw the worst lot of faces in that 
place that I ever saw in my life. 

Mr. Snyder. Yes, depravity is pictured all over their faces. 

Q. (By Mr. Snyder.) Were you not a resident physician there at 
one time? 

A. I was there during the time I studied medicine; I was in the 
insane hospital. 

Q. You know about the class of patients that they have there 
then? 

A. Yes, sir; I didn't know whether that changed or not. That 
used to be the class they had there, exactly. 

Mr. Snyder. I think the reason they get more of the depraved 
class there is because many of them are taken up on the streets 
and other places by the police. 



230 

Q. (By Air. Bliss.; The language of the report of this institution 
for 1896, is, I don't know whether you were connected with this 
institution at that time, but I would like to ask you whether you 
haYe anything further to say to the Commission about the subject 
here touched upon. The report says: "The Commonwealth, in its 
laws and in its courts, has proclaimed its watchfulness over the 
fountains of its citizenship and affixed grave penalties to any inter- 
ference with their legitimate processes. But has it taken due 
precautions to ensure sanity at the sources of human life? Ought 
not the parents of future generations to be insurable risks? "Under 
the doctrine of public policy, officers of the law already invade the 
precincts of domestic life and do not hesitate to control private 
property in respect to sewerage, garbage, ventilation, fire escapes, 
the constructions of buildings and matters of contagion. Might not 
the State be so inquisitive as to require the applicant for a marriage 
certificate to state such facts in his application as would enable 
the Committee on Lunacy of the State Board of Health to determine 
whether the applicant is mentally and physically qualified, so that 
the Commonwealth can surfer no detriment." Were you super- 
intendent at that time? 

A. No, sir; I was assistant to the superintendent then. That re- 
port was written by the trustees. 

Q. What would you say to that now? 

A. I would endorse that; that would be my sentiment to-day. 

Q. (By Mr. Snyder. i Would you care to draft something that 
would follow out that line a little further and indicate just what 
the regulation should be? 

A. I don't understand you. 

Q. In reference to the marriage laws, take the suggestions con- 
tained in that report and designate some of the questions that 
should be asked of the applicant when they apply for a marriage 
certificate? 

A. I might be able to get up something; I could not answer that 
question now. 

Q. Just think about it and if you haYe anything to offer put it 
in writing and send it to Mr. Pedrick. the secretary of the Com- 
mission, following out the line of thought and make it specific. 

Mr. Marshall. The marriage license act points out what is to be 
asked of the applicant and the idea is to extend it a little further. 

Q. (By Mr. Hall.'i I know a case where the person is 24 years 
old. whose grandmother was never in the insane asylum but always 
at home, in her later years became insane; he is engaged to marry 
a girl whose father was in this institution, would that be an advisa- 
ble match? 



231 

A. I thiiiK not. 

Q. (By Mr. Anderson.) There was a law passed at the last Legis- 
lature prohibiting firat cousins from marrying, do you think that 
was a good, law? 

A. Yes, sir; there must be some penalty connected with it. 

Q. (By Mr. Hall.) Well, now, say there are two first cousins 
having no taint of insanity, but take two persons who are defect- 
ives, that is a different case — the fitst cousins who are perfect in 
reason, knowing the law, would be governed by it but that would 
be a different case. But take two defectives who wanted to marry 
and were prohibited by law from doing so, they would much more 
likely want to live in illicit intercourse, wouldn't the mere fact 
of their being defectives have an effect on their moral characters? 

A. (No answer.) 

Q. (By Mr. Bliss.) Where the man may be personally sound, yet 
because his father died in this institution, insane, you would not 
advise that man to marry? 

A. No, sir; it is in the blood. 

Q. (By Mr. Hall.) What I mean is a different thing. Here are 
two sound persons, cousins, want to marry and here are two de- 
fectives, first cousins, you forbid them both from marrying, where 
the sane man and woman would yield to the law and be governed 
by it, but on the part of the defectives on account of their weak- 
ened condition they would not yield to it, now wouldn't that lead 
to immorality because of the likelihood of those defectives living 
in illicit intercourse? 

A. Yes, sir; that might be so. We also know that where the 
relationship is as close as that it is not a good thing and the off- 
spring is very apt to be weak-minded. 

Q. (By Mr. Snyder.) Where there are no trace of insanity in 
the parents of first cousins they are not so likely to be insane as 
weak-minded? 

A. I think so, but I think where the relationship is as close as 
that you are apt to have a degeneration. I think it is a good thing 
that first cousins should not be married; there is a tendency down- 
ward. 

Q. (By Mr. Anderson). In the removal of patients to a place for 
imbeciles would you classify the females and males together, or 
just the males, or do you think it might be possibly advantageous 
to the males, while it would not be to the females? 

A. I think not; we think that the females are just as degraded 
and we notice that here and, it seems to me, I would include both 
sexes, to be transferred after a certain age, I would not make any 
restriction. To me it is very repulsive to come across a woman 
of that kind and her influence is very bad. 



232 

Q. (By Mr. Hall.) Does a patient whose expense is paid for by 
relatives have the same treatment as those maintained by the 
State? 

A. Yes, sir; this being a State institution you could not treat 
them differently. It is simply a privilege they have and further- 
more they can remove that person without going to any public 
place. If for instance, we receive into this hospital a person where 
the friends pay, and after a certain time they become satisfied that 
they do not get along as well as they expected they can remove them 
and our objections are of no avail, but as far as the treatment is 
concerned there is no difference. If there would be any case sent 
by townships or counties and there is any improvement in them 
I send them to Hygeia Hall and we get $1.75 for that. 

Q. I thought the private patients were in a different part of the 
hospital? 

A. Not at all; they are not treated any better than the free 
patients, except if they would want to have a nurse they are allowed 
to have them at their own expense. They can have additional atten- 
tion and there is where the advantage of money comes in. 

Q. (By Mr. Bliss.) Do you not think it would be a good thing 
if institutions were established and a law passed to compel their 
incarceration in those institutions without the permission of the 
parent ? 

A. I think they ought to be all in just like all the insane ought to 
be in the institutions. 

Q. (By Mr. Anderson.) Do you think there ought to be a law passed 
to emasculate and giving institutions the power to emasculate 
males and females? 

A. That is another puzzler; it has seemed to me sometimes that 
it would be a good thing. I think, under proper regulation, it 
would be a good thing, but it would be on a par with the question 
that has been raised by different legislators who have come to 
this institution and have said, why would it not be a good thing 
to give that person just a little something to put them out of 
their misery — that might be a good thing too if it was in the hands 
of proper persons but the trouble is it might not get into proper 
hands. 

Q. You would not want the responsibility of administering chloro- 
form? 

A. No, sir; it makes no difference how unfortunate the being is, 
life is too valuable to be trifled with and we are just as careful 
with the worst cases as we are with others and are very careful 
in administering narcotics and if we were not, the friends would 
say we gave them something to hasten their death. 



233 

Q. HaTu married women been brought here and connection had 
by the husband and children born? 

A. No, sir; I have not had experience with such things. 

Q. (Mr. Marshall.) There was a case something like that here, 
where a woman was brought to this institution and recovered and 
a child afterwards born? 

A. I think the class of cases now, in connection with what you 
are talking, restrictions would be a wise thing and that is where 
a person has become insane in child birth and goes to a hospital, 
and those cases are very curable, and that woman is restored and 
goes home and has another child and comes back to the hospital and 
is again restored and goes out and has another child, I think that 
ought to be restricted — every time she comes back she has an attack 
of acute insanity. We had a case like that. 

Q. Don't you think the man ought to be operated upon w T ho does 
that? 

Mr. Hall. Yes, sir; I think so. 

Q. (Mr. Hall.) You spoke of improvable cases being let out on 
thirty days trial. If they are not well- do you think that, usually, 
ought to be allowed in cases where they are married? 

A. No, sir; I don't think so. The same restrictions should be ap- 
plied there or you have progeny that are no good. 

Q. Their natural desires would lead them together? 

A. Yes, sir. 

Q. (By Mr. Bliss.) Mr. Geary said that the husband was less 
anxious to get the wife out? 

A. No, I haven't been impressed with that; I think when they 
come for them they are about equally anxious, both man and wife. 

Q. (By Mr. Snyder.) I think Mr. Geary's experience is confined 
entirely to Blockley? 

A. Yes, sir. 

Q. They are a different class of patients? 

A. That has been a great annoyance to me because I knew what 
would happen to the woman restored; for the time being she passed 
through acute insanity. It was a case of puerperal insanity and 
if she had not passed through that she would have remained that 
way. 

Q. (By Mr. Bliss.) What effect would that be likely to have 
upon her children, that kind of insanity? 

A. I think there would be a weakness to all of them. 

Q. There might not be in the first? 

A. No, sir; but the subsequent ones. For the first one it might be 
all right but the idea of bringing into the world a number of defect- 
ives seems horrible. 



234 

Q. (By Mr. Hall.) There are three down at Polk institution from 
one family in Cambria county, two sisters and a brother, and it does 
seem horrible. 

A. We have a number of sisters and brothers but that is an 
extreme case that Mr. Shirk mentioned, two sisters, mother and 
son. 

Q. (By Mr. Marshall.) You never tried to go back and find their 
ancestry? 

A. It is very difficult to get at that; there is every effort on the 
part of the parents to hide it. 



LEGISLATIVE COMMISSION TO INQUIRE INTO THE CONDI- 
TION OF THE PENNSYLVANIA INSANE. 



Inspection of the Willard State 
Hospital for the Insane, Wil- 
lard, New York. 



MAY 28th, 1902. 



( 235) 



dUk 



£& 




ass 



a m m 






( 236) 



INSPECTION OF THE WILLARD STATE HOSPITAL FOR THE 
INSANE, WILLARD, NEW YORK, MAY 28, 1902. 



The Commission arrived at the Willard State Hospital for the 
Insane, in the state of New York, on Wednesday, May 28, 1902, at 
11.45 P. M. 

On Thursday, at 9.30 A. M., Dr. William A. Macy, superintendent 
of the institution, together with three members of the medical staff, 
met the Commission and a tour of inspection began. 

It was stated by Dr. Macy that he very much regretted they 
could not entertain the Commission within the administration build- 
ing for the reason that they had an epidemic of diphtheria. 

The first building inspected was one for working men and in 
connection therewith was a clothing department where all the cloth 
ing was numbered by means of which each patient was able to 
get his clothing without mistakes occurring. There were also in this 
building a system of shower baths. 

A number of large silos were also observed in connection with 
the various barns as they were passed. 

Dr. Macy stated that they found it a great benefit to keep the 
insane employed and they did nothing with paid help that they could 
do with the patients. 

"We have seven groups of buildings. The diet is different for 
the chronic insane and the acute. We have a staff of physicians 
and they are scattered around and some will have the care of from 
four to five hundred of the chronic class, where they do not require 
much attention; but with the acute patients we reduce the number 
of patients as much as possible to the physicians. Every now and 
then a man gets up and wants to know why we cannot take care of 
the insane for less expense, and at times there is some grumbling, 
but it soon subsides when people get to understand something of 
the work that is being done in the institution. The Colony system 
is a little more expensive but it gives better results. We have a 
remarkably good class of people here. Our country girls come from 
families that are reasonably well to do." 

One of the barns was next visited and everything connected there- 
with was found to be arranged in the most approved method of 
barn building. In passing along the fire engine was pointed out. 
"We can get our engine at work on any building in eleven minutes 

( 237) 



238 

from the time of the alarm. Our firemen, however, are only from 
among the paid attendants. None of our patients are supposed to 
assist in putting out a fire as the excitement on such an occasion 
would be too great for them." 

Dr. Macy also pointed out pleasure grounds for the recreation 
of the patients; also gardens where patients were seen at work, 
fields of corn, potato patches and berry patches on which many 
patients were seen hoeing and digging and otherwise cultivating 
the products of the earth, all the fields seeming to be under a high 
state of cultivation. 

Hadley Hall was also visited. On the lawns near this amusement 
hall were seen many patients in recreation. "This hall was built 
in 1892 and will seat about twelve hundred people. When we have 
amusements we sell our galleries and in that way make up part 
of the expenses. If we get a visiting entertainment it co®ts quite a 
sum. The State gives us three cents per capita and that together 
with paid admissions goes to keep up the band and orchestra. 

"Sometimes we are favored with very good talent and of course 
it is quite a diversion for the patients. Religious services are held 
every Sunday in this hall; the services are conducted by clergymen 
of different denominations. We give our patients a dance every 
week, and the employes once a month, and troups come in as we can 
afford it. In the dances that we have the women attendants dance 
with the male patients and the men attendants dance with the 
female patients, and thus we have no difficulty in preserving order. 
We utilize our employes in the formation of an orchestra. In the 
summer time we have ball games for their amusement. We make 
up a team out of our employes and that is done on their own time 
so that the hospital really loses nothing by it. We get a number 
of teams every season from the outside and usually pay their rail- 
road fares. The male employes number about 225. Our proportion 
is about one to twelve; that means day attendants, night attendants, 
dining-room help and all the rest. All the work on the roads, 
lawns, in the gardens and fields and about the premises is mostly 
done by the patients. All our attendants wear uniforms. We do 
not take any private patients and the cost is limited to $3.50 per 
patient a week. The counties do not pay for maintenance but it is 
paid by a state tax levied for that purpose. The land belonging to 
the institution is about 1,200 acres. Eleven counties comprise the 
district. We have about 40 sheep, 50 horses and about 140 milch 
cows. We have about three miles of railroad tracks on the grounds 
which reach all the buildings and this does away with the use of a 
great many teams for hauling. We have our own track hands and 
one-half of the expense is kept up by the railroad company and the 



239 

other half by the institution. Whenever our water supply fails 
we resort to the lake for water. In ordinary seasons we have plenty 
of water but in dry seasons we have to go to the lake. That water 
out there (pointing to Seneca Lake) is 600 feet deep. We have our 
acute cases on each side of the main building, known as the Admin- 
istration building. We have about 600 patients in this building. 
W T e have no hospital building but we have wards arranged very con- 
veniently for that purpose. We have a complete telephone system 
arranged throughout the grounds so that any building may be com- 
municated with." 

A visit was made to the building occupied by the chronic insane 
women, which included an inspection of the kitchen, laundry, dining- 
rooms, bed-rooms, &c. 

In the drives to the various buildings an opportunity was given 
to observe the excellent roads and concrete pavements along the 
roadsides which afforded good walks for the patients. 

A row of houses was pointed out as the homes of the employes. 
"We put our able-bodied patients to work at anything we can find 
for them to do. They work in the fields, vineyards, berry patches, 
in the shop and in fact at almost any occupation, except we do not 
use them for carpenter work. We also have a quarry on the prem- 
ises where we get our road material and the roads through these 
grounds have been made by the patients. The State appropriates 
a certain amount of money towards the maintenance of roads and 
the counties contribute a certain amount, and there is no tax worked 
out on the road as I understand is the case in Pennsylvania. We 
have a road roller and stone crusher that is utilized in connection 
with our road work. We use all our grapes. Last year we canned 
about 8,000 can® of tomatoes. The idea is to increase our canning 
capacity and other work and increase the diet and thus bring about 
good results all around. We do not buy anything that we can pro- 
duce ourselves. We make all our brooms, brushes, baskets, mat- 
tresses, clothing, boots and shoes and make them just as we want 
them. We do not manufacture cloth but we make it up into cloth- 
ing. Of course we cannot shut out articles made in institutions of 
other states. They thought they could, but it could not be done 
and the great difficulty is that we have shut out our own prison labor 
and some of it now comes in from other states. I believe that 
has also been accomplished in Pennsylvania, and it would be all 
right if it were not for the fact that it comes in from other states and 
we become the dumping ground for them. I can't see what benefit 
it is to shut this labor out of our own prisons if other states are 
permitted to go on and manufacture and send their product into our 
state. Our buildings are not fire-proof, I think it is much better 



240 

if au insane asylum is near a large town, say a town of ten to fifteen 
thousand population, on account of being better able to keep the 
employes, because then they become interested and have society 
and there is a likelihood of their staying longer in their positions. 
If they are near a large town they have their own churches and form 
friendships and have social enjoyment which bind them to the place. 
That is the only disadvantage I find here. The institution might 
be three miles away from the town. Of course you would have 
to select your town. I have had experiences under both circum- 
stances and I have come to the conclusion that it is best to have an 
institution of this kind located near a large town, not only because 
it gives the employes some social opportunities but also because it 
gives the medical men connected with the institution an opportunity 
to mingle with other of their profession and have an interchange 
of views. We have no nurses' home where they can enjoy themslves 
alone but we have a men's room. They are on duty from 
ten to sixteen hours. I think it would be a good thing to have a 
separate nurses' home and give them the enjoyment of their individ- 
ual life and not let them think that they are 'herded.' That is what 
we are trying to do in New York. We can get any quantity of 
help and we weed out and get the best we can. The Lunacy Com- 
mission fixes the salaries and wages of employes and attendants. 
We have a Board of Charity that looks after all the insane institu- 
tions of the state. We pay $2.14 per ton for our bituminous coal, 
including freight; it comes from the Rochester and Pittsburg Com- 
pany. The Lunacy Commission is given entire control of the insane 
asylum. The expenditures are made through their board of mana- 
gers and no purchases can be made without their approval. They 
appoint the superintendents and stewards. The superintendents 
appoint all the employes and the board approves them. The board 
make allowances every two months and the superintendents make 
contracts and the supplies are purchased through the steward. Oar 
law requires us to buy by joint contract as far as practicable and 
the result is we have a meeting of the board of superintendents and 
stewards two or three times a year. We get together and make an 
estimate of what we think would be an advantage to buy in bulk 
and then we advertise for such articles. Sometimes there is a little 
tendency to force in certain supplies that one hospital can get to 
a better advantage nearer the institution than another and then a 
consultation takes place as to what shall be done. We have, how- 
ever, in the end, to do as the Lunacy Commission suggests and 
directs. The stewards meet on call but the superintendents meet 
two or three times a year. To attend these meetings some are nec- 
essarily required to go longer distances than others. We found in 



241 

having too frequent meetings it required a great deal of time away 
from the hospital on the part of the superintendents, and I know 
there have been occasions in which I have been away as long as 
three days at a time. As often as may be necessary the stewards 
are called in but usually through the superintendents so as to throw 
the unprofessional work as much as possible away from the superin- 
tendent, but he still maintains his supervision to see that every- 
thing is done for the best interest of the patient and institution. 
When it comes to medical matters the superintendent is recognized 
throughout. He is required to be a physician of five years experi- 
ence in some insane asylum. The head of the Lunacy Commission 
must also be a physician of some experience. The members of the 
Lunacy Commission receive five thousand dollars per year. 

"We have been troubled here with an epidemic of diphtheria for 
the last three years and have had 163 cases in that time. I have 
had it myself. We have none now except in one of the wards of 
the main building. We fixed a ward as a detention ward. We have 
thoroughly disinfected and gone to radical ends to meet the trouble, 
using fromaldehyde. We have had but three deaths out of the 163 
cases and we feel quite proud of that. We have made between 
seventy and eighty thousand cultures in antitoxine. We have had 
every variety of cases. We depend on antitoxine in every case. We 
get it from Mumford in Philadelphia and some from the Board of 
Health in New York. We have a first class equipped laboratory. 
We have tested out a lot of problems in connection with this disease 
which have been bothering the specialists; and the more you investi- 
gate the more discoveries you are able to make. It is a deep subject 
and we find a variety of types of diphtheria. We had one woman 
who had it, in the most aggravated form, in the vagina. Diph- 
theria will attack any raw surface. Our experience shows that the 
germ will find lodgment in places that the average physician least 
suspects. I think there is a great field for original search by our 
state and national government in this direction as a betterment for 
the public health. We have all sorts of investigation in connection 
with agriculture and the betterment of such pursuits, but it seems 
we have not thought it necessary to make these researches in 
human life. 

"The establishment of an institution like this is the outgrowth 
for the betterment of the insane, particularly in county poorhouses. 
At one time there was no idea of appropriate care. The patients 
were often allowed to intermingle both sexes and it was a common 
thing to erect a cheap building. I have seen in the summer time 
buildings erected fifteen by twenty feet divided off into four cells, 
and four patients put in there and allowed to go even without 
16 



242 

clothing; that was the extreme of the old system. The condition 
of the insane in the poorhouses attracted the attention of the phil- 
anthropists and it resulted in the appointment of Dr. Williard, who 
was chairman of the Lunacy Commission, to investigate the condi- 
tion of the insane. We have all his data in our library. The con- 
ditions were found to be so bad that it resulted in this hospital 
which was named after Dr. Williard. This was the second one 
built. As matters went on from year to year they finally found 
that the movement in taking care of the insane, as people began 
to appreciate their care, was not increasing with the insane and they 
began to build more hospitals and thus we were enabled to get a 
better classification and give the patients a better life, which was 
only obtainable under some such system. By bringing the chronic 
and acute together in the amusement hall, which is for both classes 
of patients, we find it is beneficial to them. Our custodial building 
then supplies for the acute cases. You would think that putting 
them together would affect the acute cases but our experience is 
the reverse. Our experience is that he will recover very much quicker 
than if he is given home treatment. The first thing that dawns 
upon them is the incongruity of their surroundings in comparison 
to what they were accustomed to. I do not favor putting the acute 
separte in one institution because ordinarily these people work like 
other people, and you would deprive the institution of the benefit 
of them in fitting up the grounds and in taking care of the others. 
There are lots of the chronic cases we can use as hospital helpers 
in cleaning floors and cleaning up the wards. As they are quieted 
down they are put in a quiet ward. Our classification is according 
to both mental and physical condition. True it is, there might be, 
two acute cases that we would not put together, and there might 
be two chronic cases that we would not put together. We would 
like, in an institution like this, a separate building for the acute 
hospital cases but when they cease to be acute then we can move 
them into the wards. I approve of the cottage system. As to hav- 
ing them entirely separate depends on the number of people you 
are going to take care of and of course you would plan very differ- 
ently for 250 than you would for 1,500. In the cottage system I 
would limit it to about one thousand patients, if I could. We are main- 
taining over two thousand patients here and of course you would 
reduce the cost if you put them very compact. When you come to 
the cottage system you have your attendants' rooms and heating 
and all that which would somewhat increase the cost, but in my 
opinion the increased efficiency counterbalances the increase of the 
expenses and that would mean the betterment for these poor un- 
fortunates." 






243 

In the afternoon, at 1.30 o'clock, Dr. Macy, with others, again 
called for the Commission and in carriages the tour of inspection 
was continued. 

The administration, or main building, was visited and the Com- 
mission was conducted into a room where the X-rays were exhibited 
and the electric current applied. In the convalescent ward it was 
explained that there were about 350 patients. The bath room was 
visited and the attendants in charge demonstrated its utility in 
giving various kinds of baths. "We spray them all here in the fore- 
noon and in addition to that we have medical baths and a hot box 
for giving vapor baths, which you see there in the corner and 
which only admits the head to be exposed through that opening." 
The Commission also visited the dining room, operating room, the 
bakery, where there is an average of 1,600 loaves of bread baked per 
day, the kitchen, the dining-room for employes, the storage build- 
ing and work shop. In the tailor shop was seen an electric cloth 
cutter used in cutting 44 thicknesses of cloth at one cutting. The 
patients in this department were engaged in making clothing of 
all kinds. There were about seventy-five women and about fifteen 
men patients working in the tailor department. In the shoemaker 
shop patients were making boots and shoes as well as doing repair 
work. In one of the work shops patients were seen weaving carpet, 
making mattresses, harness, all kinds of brushes, small and large, 
baskets, rugs, brooms of different varieties; in this department 
there were about twenty-five patients engaged in the various occu- 
pations. Their hours of labor are from 7 o'clock A. M. until half 
past eleven, and in the afternoon they go to work at 1 o'clock and 
quit at 5 o'clock. The store room was also visited. In the labora- 
tory members of the Commission were shown diphtheria germs by 
means of a microscope. The usual clinical work is carried on in 
the laboratory. The laundry was visited and it was stated that there 
were one hundred patients, on an average, engaged in laundry work 
and that about fifty thousand piece® a week are laundered. The 
tin shop was visited and in this department patients were engaged 
in making useful articles. 

Among the last places visited was the infirmary building for 
men, it being intended for the terminal cases and those suffering 
from tuberculosis. In this building were seen aged men in the last 
stages of consumption. Some of the inmates were in bed, some 
were sitting on benches and others moving around in a large room. 
It was stated that there were 184 patients occupying the building. 

After returning to the car Dr. Macy remained with the Commis- 
sion for some time and a conversation was engaged in by himself 
and members of the Commission. 



244 

Dr. Macy. In speaking about the care of the insane, times have 
very much changed with reference to their treatment. Our old 
steward, who died last October, told me they had one case come 
to this institution in a box and had him nailed up, in which there 
was a hole for his head to stick out and that was the kind of care 
people thought he ought to haYe in transit. Another case was 
brought in at one time by a constable, and although it was a cold 
day, yet they brought him to the steamboat landing and put him 
on board and chained him to one of the stanchions on the deck 
and they went in where they were warm, and the old captain of the 
boat saw the predicament in which the patient had been left, went 
out and loosened the man and brought him into the cabin and he 
was as quiet as any one. They told him he should not do that be- 
cause if he did so he would do it at his own risk. They were all 
afraid of him and on that account tied him. That shows what the 
ideas were formerly concerning people who got insane. This man 
they brought here in a box got well and went home and died. I 
would rather have a mixed farm and a variety of occupations. 
There is about $33,000 worth of products raised on the farm. 

Mr. Hall. If you had to go into market and pay cash for those 
products it would cost far more than you make in that estimate? 

Dr. Macy. Yes, sir; that labor is so much saved. It is some- 
thing that if we did not do in this way would be absolutely lost. 
One of those women we passed in the laundry is a very good 
worker and she thinks she is going to be paid. Every now and 
then she comes and presents a bill and she says she expects to 
have her lawyer call upon me and have her pay, no matter whether 
I represent the state or not. 

Mr. Hall. Have you ever known of a person being wrongfully com- 
mitted, not mistakenly but wrongfully committed? 

Dr. Macy. No, sir. 

Mr. Hall. When I was put on this Commission I was written to 
by a number of persons who had that idea. 

Mr. Anderson. You remember that young man from Virginia 
who married, I think his name was Chandler, there was some doubt 
about his insanity. What was his condition? 

Dr. Macy. I think he was insane and is yet. He was committed 
to Bloomingdale. There is no institution higher in the world than 
that one and they would not admit him there unless they were sure 
of it. It is a charitable insane asylum and they are exempt from 
taxation by being charitable. It is a department of the New York 
hospital. What they make they turn in. They take some without 
pay and some are below paying rates. If a worthy case comes to 
their attention they will admit them free. They carry fifty to sixty 



245 

for nothing and have a board of managers and that board is author- 
ized to use their discretion and they are very liberal. They claim 
they expend an average of ten dollars a week on their patients. 
They take some as low as fifty to seventy-five cents a week. 

Mr. Hall. Have you any provision of the law which permits 
persons, who believe they are becoming insane, to come here and 
consult you? 

Dr. Macy. No, sir; we have nothing except by commitment. I 
think it is a good thing. We have here at this hospital a certain 
number of patients who have been here before, or hear of this hos- 
pital, who go to their physicians and desire to be sent here for the 
reason that they feel they are breaking down and I think the num- 
ber is becoming larger and larger. It is not my opinion that in- 
sanity is on the increase, but it is on that account. 

Mr. Hall. I see in your report that 44 per cent, of the admissions 
since the 1st of October, 1890, were of foreign parentage. Have 
you ever thought why there should be that percentage, is it because 
those people have come away from home and family ties are broken? 

Dr. Macy. Yes, sir; possibly that and being away from their na- 
tive land. A great many are deprived of opportunities and con- 
veniencies that they have at home among their friends, and the 
men get into bad habits and all that. 

Mr. Hall. Do you think the excitement of city life is any worse 
than the dead monotony of country life in causing insanity? 

A. I think it is about the same; I don't think it is the strenuous 
life of the city but I think it is the opportunity for dissipation. 

Q. Do you think a married man or married woman committed 
to this hospital and recovers to such a degree as to allow him or her 
to go home, that it is safe to allow them to go home? 

A. I think I see what is behind that; I don't see any way to pre- 
vent it. 

Q. In puerperal mania, do you think a woman who became insane 
after the birth of her first child and came here and was cured and 
went back home and at the birth of another become insane, until 
she would have six, should be permitted to leave the institution? 
There is a woman of that character in the Warren asylum under 
those circumstances. 

A. We have the same condition here to some extent. 

Q. Don't you think they ought to do something with the hog that 
married her? 

A. You might think it should be done but I hardly see how it can 
be done. In the medical local society of New York we had a great 
discussion in which Dr. Hammond, of Washington, and Dr. Spitzka, 
of New York, participated and others took part, pretty well repre- 
senting the medical profession in Washington, New York and Balti- 



246 

inore, and we made up our mind that the time was not ripe for that; 
that common prejudice would overcome us and the question came 
up with reference to whom you could entrust this power. 

Q. (Mr. Snyder.) There was an act passed in our State at the last 
session of the Legislature, making it illegal for first cousins to 
marry; what do you think of that? 

A. I think that is a good thing. On this question of deciding 
who shall have this power, the fellow who has the power might do as 
I did once, although I did it through mistake. I had an Irishman 
come into the dispensary one time and wanted me to extract a 
tooth; I thought he had as good teeth as any I had ever seen but 
he insisted that I should extract a tooth and pointed to it and I took 
the forceps and got hold of that tooth and blistered my hands with 
the forceps and after I had it out he damned me because he said 
I took the wrong tooth. Well now a person exercising that power 
might pull the wrong tooth. 

I don't think I was more taken back than driving to the stable 
one day and there was a patient there and I did not want to leave 
the horse with him and I got out and I says, Mr. So and So, is the 
stableman in there? Yes, he is in there; and I said won't you ask 
him to come here? And he looked up at me and says "you are not 
very busy, suppose you call him yourself.-' 

One of my friends came in the other day and handed me a little 
clipping from a magazine representing a scene outside the wall of 
an insane asylum with a man there fishing and an insane man on 
top of the wall looking over and saying, what are you doing? Fish- 
ing. How long have you been there? Six hours. Have you had 
a bite? No. The insane man says, "come inside." 

Q. (Mr. Bliss.) Is there any other institution in the state as large 
as this? 

A. Yes, sir; two at least, one at Ward's Island for women is about 
as large. 

Q. I mean whether there are any away from the cities as large? 

A. Y"es, sir; one at King's Park has about three thousand. 

Q. How many have they at Matteawan? 

A. Seven or eight hundred. 

Q. What class of cases? 

A. Criminal. 

Q. (Mr. McClain.) Did I understand you to say that it was best 
to have asylums limited to a thousand (stated in general testimony)? 

A. I think where you had the means, but from an economical 
standpoint they would not be so good, from a scientific standpoint 
it would be best. 

Q. (Mr. Bliss.) State whether your average per capita cost here 



247 

is a fair guage as to the average cost in other similar institutions in 
the state? 

A. Some more and some less; the average for the whole state 
last year was $3.56. 

Q. Would your average be lower because you worked more here? 

A. I think it is because of our farm. I think we do more work 
than some of the institutions, not more than all of them. 

Q. I don't think the amount of labor in any of our institutions 
is anything like it is here except at Wernersville, at which place 
we have an asylum devoted entirely to the best character of insane 
and the chronic insane are transferred from all the different state 
hospitals to that hospital, and there the per capita is very low but 
I doubt very much whether it is the most economical, (a similar 
question being asked and answered given in the general testimony). 

A. This was an institution for the chronic insane at one time 
but there is no question that w 7 e have greater efficiency under this 
system than we had before. It cost about the same as it does 
to-day. It did not include clothing, wear and tear and officers 7 
salaries. I collected all that matter and added it to the fixed charges 
and I found during the time Dr. Chapin was here, and he was here 
about fourteen years, that it cost about $3 per week and they had 
none here but purely chronics. 

Q. (Mr. Hall.) Then we might as well do away with the chronic 
insane asylum? 

A. We have done that here. 

Q. Take an asylum for the chronic insane, why not take all those 
people away from here and leave the remainder with you, wouldn't 
that relieve you? 

A. If that was done the expense would be increased and your 
work would be paid labor. Where would you gain anything? You 
would increase the cost for those you would leave here. 

Q. You say that building, in which were the old people, is the 
terminal building, it is only a question of time with them? 

A. That is the end. 

Q. If they were all taken to one place wouldn't you be greatly 
relieved? 

A. It would relieve us of a great deal of executive work but why 
should we not take care of those people? We have to look at that 
from the standpoint of disagreeable work. If you remove those 
people your cost would be vastly increased because we are taking 
care of the chronics by some patients who are able to work, whilst 
if they were in a separate institution you would have to employ 
all paid help. 

Q. (By Dr. Murdoch.) That class of chronics require a great deal 
of laundry work and it can be done bv others who are able to work? 



248 

A. Yes, sir; we tried it here for years, from 1869 to 1890, and we 
abandoned it. 

Q. (By Mr. Snyder.) Then you have no separate hospital for the 
chronic insane? 

A. No, sir; we w T ent to work and changed this all over. As I 
have said, this institution was at one time an institution for the 
chronic insane. They talk of it frequently but they do not stop 
to figure up the disadvantages. 

Q. (By Mr. Bliss.) I am not so sure that the county care is not a 
good thing provided it is under the control of a state board like 
your State Lunacy Commission, who are paid and can supervise 
and direct it, not a large county but two or three counties go to- 
gether and make a district of them, don't you think it is a good 
thing to have the patients near their family and friends where 
they can be visited every week or every two weeks? 

A. A great deal can be said on both sides and I think it over- 
balances in favor of the district system. If you could have it as 
in Wisconsin and pick out ideal people for every hospital it might 
be all right. 

Q. They do that here now; have a central board and it would 
make perhaps thirty to thirty-five state asylums instead of a dozen? 
A. Your economy would be on the other side of the sheet. 
Q. How would it affect the patient? 

A. I don't think it would affect the question largely because those 
who can afford it will come to see their friends there. 

At the conclusion of the inspection the Commission were invited 
to the office of the superintendent, where the following took place: 

Mr. Snyder, Chairman. The Legislature of Pennsylvania, realizing 
the present crowded condition of the hospitals for the care and treat- 
ment of the insane, in the State of Pennsylvania, appointed a Commis- 
sion to examine and make inquiry and recommend to the next 
Legislature some established basis which will afford the most modern 
and approved methods for the treatment of the insane. 

We have understood that your institution has a system by which 
the patients are furnished light employment and it has been found 
to be very beneficial to them and through your kindness we came 
here to examine into your system and if by the knowledge we have 
received here we are able to report to the Legislature something 
to improve our present system of caring for the insane, not only 
are you entitled to the thanks of the Pennsylvania Legislature but 
the thanks of the people of the entire State as well and I extend 
to you, in behalf of the Commission and the State of Pennsylvania, 
sincere thanks for your extreme kindness and courtesy in showing 
us over the grounds and through the various buildings connected 
with this splendid institution. 






249 

There are some general questions we have been asking the super- 
intendents of Pennsylvania and whatever you will answer we will 
be glad to have and whatever you do not desire to answer may be 
passed over. 

Dr. Macy. In reply I desire to say that any information I can 
give your Commission I will be glad to do. There is no reason why 
there should be any reservation on my part. 

We have a system that is called a mixed system here and very 
much like every hospital in the state. I do not claim anything 
for Williard except what we are trying to carry on in all the hos- 
pitals of the state of New York. Possibly in farming operations 
we may excel other institutions of the state on account of increased 
facilities but other institutions may excel us in other things. 

The state officers desired that I should meet you in this matter 
and do everything I could in giving you information on subjects 
that are being investigated by your Commission. I desire to ex- 
press the regret of Dr. Peterson, chairman of our Lunacy Committee, 
that he could not be present with us to-day. This arrangement 
was made originally before the abolishment of the board of mana- 
gers and when I had notice from Mr. Pedrick of your coming I at 
once telegraphed to Dr. Peterson and found they had a meeting 
to-day in Albany, which prevented his being here. I received a 
letter from Dr. Peterson this morning expressing great regret that 
he could not be w r ith us and he also expressed a desire that you visit 
the institution in the state for epileptics. 

Our institution here is the second in the state. We have the 
opportunity for separate classification, separating all the chronic 
cases from the acute and if we are able to acquire additional facili- 
ties in equipment there should not be any complaint and we will 
be able to give better returns and results to the state at a lower 
rate. 

Q. (Mr. Snyder.) What method do you adopt for obtaining em- 
ployes, nurses and others? 

A. We have a large number of letters sent us constantly from all 
over the state and oftentimes letters come from the extreme ends 
of the state requesting employment by people who know of our insti- 
tution. There are a large body of employes who follow this service 
and it often occurs that they desire to change so as to be nearer 
home and all that. In addition to that, if we find we are running 
short of help, and it is usually women attendants rather than men 
attendants, we send to other institutions and find out how many 
they have on their eligible lists. Only last night I got a list of 
thirty names. In those cases we write circular letters to all of 
those people stating that we have vacancies and also asking if they 
are desirous of becoming applicants we would like them to fill out 



250 

the blanks that we send them and after their receipt we consider 
them; and a large number are filled in that way when we have not 
sufficient on our own eligible list. We never found it necessary to 
advertise. Some of the institutions in the state do advertise, par- 
ticularly those near the large cities, such places as on Long Island. 
From what I have heard they advertise in the rural papers up 
through the state in the different counties and in that way secure 
a good many employes. We never found it necessary to do that 
here, but with our women list sometimes we found it practically 
exhausted. 

(Copy of blank application attached to the record.) 

Q. What is the eligible list? 

A. A list of the names of persons sent in as desirable to be em- 
ployed for such purpose. 

Q. Not through examination? 

A. No, sir; we give them the examination ourselves. The an- 
swers they make in the application papers is considered a partial 
examination and as soon as those applications come back we write 
to their references asking for information about them and if we do 
not find enough on these papers we ask particular questions and 
classify them according to occupation. For instance, we classify 
all those that are muscular by themselves and those having no 
trades we put by themselves. We then put them on files so we can 
turn to them readily and there is a heading on the list which shows 
what they can do. 

Q. Your supplies are all obtained through the Lunacy Commission? 

A. All obtained on estimates and those estimates are sent in. 

Q. By competitive bids? 

A. Very largely and on actual advertisement for supplies. 

Q. How often are those competitive bids made? 

A. Some of our supplies are advertised for once a year, some of 
them twice a year, some by the month and some obtained on open 
bids without advertisement. Here is a copy giving a full estimate 
of the wages and supplies for June and July (referring to an ac- 
count book). 

Q. Who is that estimate presented to? 

A. Presented in triplicate to the State Commission in Lunacy. 
One goes to them, to their office, one is forwarded to the State 
Comptroller and the other together with all changes is returned 
to the hospital. 

Q. What is the average proportion numerically of your attendants 
to the number of your inmates? 

A. I will give you that from our report which will be more accu- 



251 

rate: One to nine 44-100; our average is about one to ten. 

Q. What has been the result of the industrial training of your 
patients? Our object in asking these questions is to get informa- 
tion on these subjects so we can present the testimony in the report. 

A. In a general way it is of extreme benefit to cases that are 
suited and that condition, in which this occupation begins with 
some, is in the acute stage and extends to almost all of the chronic 
cases of the hospital. There are a number never will do anything, 
but by varying the occupations we are able oftentimes, after the 
lapse of months or years, to secure the actual employment of pa- 
tients who would never before do anything and in that way stay 
the advance of dementia and make their condition better. 

Q. What percetnage of your patients work? 

A. From 50 to 53 per cent. 

Q. Have you women physicians? 

A. Yes, sir. 

Q. The nurse attendants in the women department are women? 

A. Yes, sir. 

Q. How many hours are they on duty? 

A. Their hours vary according to different kinds of employment, 
from eight to ten hours, and then we have what we call the long 
and short day, three different hours. With the ward attendants 
proper there would be ten, twelve and sometimes even longer, four- 
teen or sixteen hours; that depends largely upon the number on duty, 
the number that happened to be away sick, on vacations and matters 
of that kind. 

Q. How many patients have you in your institution at the present 
time? 

A. I say 2,260. 

Q. About what proportion are males and what proportion are 
females? 

A. About half and half. I have here the report for May 24th 
(referring to statement); we have 2,258, and of those 1,142 are 
women and 1,116 men. 

Q. Do you place restrictions upon communications by letter to 
or from your patients? 

A. Only as to the supervision. We require that all the mail com- 
ing and going shall be supervised by the physicians; at the same 
time all mail addressed to the Governor, Secretary of the Slate, 
Attorney General, District Attorney, any judge of the court, I 
think one or two other officials are mentioned, goes without any 
scrutiny; although I would say in addition that the ratio of the 
attendants to patients at the time of making this last report is 
thrown out a little from the fact of this epidemic of diphtheria. 



252 

When we made it, it was one to nine 44-100, but our average is 
about one to ten. 

Q. What formula is adopted to obtain the admission and also the 
discharge of patients? 

A. All patients committed by the courts, through the judge oi 
the first court of record. We have first the petition of the rela- 
tives to the court and by getting it before me I will give it to you 
logically. We have the petition of the nearest of kin, or the 
person who is authorized under the law to make this petition. I 
think I can give it to you better if I read it. It goes on and gives 
the order for commitment of an insane person and provides for 
medical examiners in lunacy and providing for certificates of lunacy 
by two reputable physicians, and then reads as follows: "Any 
person with whom an alleged insane person may reside or at whose 
house he may be, or the father or mother, husband or wife, brother 
Or sister or the child of any such person, and any overseer of the 
poor of the town, and superintendent of the poor of the county in 
which any such person may be, may apply for such order, by present- 
ing a verified petition containing a statement of the facts upon 
which the allegation of insanity is based and because of which 
the application for the order is made. Such petition shall be ac- 
companied by the certificate of lunacy of the medical examiners, 
as prescribed in the preceding section. Xotice of such application 
shall be served personally, at least one day before making such 
application, upon the person alleged to be insane and if made by 
an overseer or superintendent of the poor, also upon the husband 
or wife, father or mother or next of kin of such alleged insane 
person, if there be any such known to be residing within the county, 
and if not, upon the person with whom such alleged insane person 
may reside, or at whose house he may be. The judge to whom the 
application is to be made may dispense with such personal service, 
or may direct substituted service to be made upon some person 
to be designated by him. He shall state in a certificate to be at- 
tached to the petition his reason for dispensing with personal 
service of such notice and if substituted service is directed, the name 
of the person to be served therewith. 

"The judge to whom such application is made may, if no demand 
is made for a hearing in behalf of the alleged insane person, proceed 
forthwith to determine the question of insanity and if satisfied 
that the alleged insane person is insane, may immediately issue 
an order for the commitment of such person to an institution for 
the custody and treatment of the insane. If, however, it appears 
that such insane person is harmless and his relatives or a commit- 
tee of his person are willing and able to properly care for him, 



253 

at some place other than such institution, upon their written con 
sent, the judge may order that he be placed in the care and cus- 
tody of such relatives or such committee. Such judge may, in his 
discretion, require other proofs in addition to the petition and cer- 
tificate of the medical examiner. 

"Upon the demand of any relative or near friend in behalf of 
such alleged insane person, the judge shall, or he may upon his 
own motion, issue an order directing the hearing of such application 
before him at a time not more than five days from the date of such 
order, w T hich shall be served upon the parties interested in the 
application and upon such other persons as the judge, in his discre- 
tion, may name. Upon such day, or upon such other day to which 
the proceedings shall be regularly adjourned, he shall hear the 
testimony introduced by the parties and examine the alleged in- 
sane person if deemed advisable, in or out of court, and render 
a decision in writing as to such person's insanity. If it be deter- 
mined that such person is insane, the judge shall forthwith issue 
his order committing him to an institution for the custody and 
treatment of the insane, or make such other order as is provided 
in this section. If such judge can not hear the application he may, 
in his order, directing the hearing, name some referee, who shall 
hear the testimony and report the same forthwith, with his opinion 
thereon, to such judge, who shall, if satisfied with such report, 
render his decision accordingly. If the commitment be made to a 
State hospital, the order shall be accompanied by a written state- 
ment of the judge as to the financial condition of the insane person 
and of the person legally liable for his maintenance as far as can 
be ascertained. The superintendent of such state hospitals shall 
be immediately notified of such commitment, and he shall at once 
make provisions for the transfer of such insane person to such 
hospital." 

(Copy of law and blank attached to the record.) 

The judge's actual commitment concludes that proceeding and we 
have an actual commitment in each case. There are some excep- 
tions taken by some of the judges to this commitment very lately, 
as to waiving notice to the patient. Certain lawyers have held that 
the service should be made in all cases. There is a good deal of 
objection to this because it necessitates an actual trial of a person 
who is under control, not because of any trial. 

Q. Do you have a conference of your superintendents several 
times each year? 

A. We have had up until the present, up until two or three 
months ago, for the period of three years prior to that every month. 

Q. The superintendents of the institutions are fourteen? 



254 

A. About that number. 

Q. And in case of an outbreak of an epidemic, or contagious dis- 
ease, you have a separate house where they are quarantined? 

A. There is no separate provision made for our institution bat 
in the case where that has occurred the Lunacy Commission has 
always placed means at our disposal to make such provisions. At 
this place we had an old farm house and vacated it and set it apart 
for that use and in addition to making temporary provision they 
have allowed us to purchase tents and other equipments. Just at 
present we have a small outbreak of small-pox in one of the hos- 
pitals. 

Q. What kind of patients do you treat in tents? 

A. Patients such as do not run away. We are thinking of keep- 
ing some there this summer, by caring for our consumptives on 
account of the crowded condition. At Manhattan they care for the 
consumptives the year round in that way. 

Q. What is your system of religious observance and also of your 
amusements for the insane? 

A. The religious observances we provide might be divided under 
two heads, Protestant and Catholic services, and near this hospital 
we happen to have some two or three Protestant clergymen and 
two or three Catholic clergymen in nearby towns, and there is an 
appropriation of one thousand dollars a year made for the payment 
of those expenses and that is divided between them. In other 
hospitals they are likely to have one Protestant and one Catholic 
chaplain, or provide for one Sunday service. All are paid the same, 
both the Protestant and Catholic clergymen. 

Q. Do you believe that the application of civil service principles 
for employes in the various departments of your hospital is bene- 
ficial? 

A. I do. 

Q. How is that arranged, this sheet is filled out? 

A. Yes, sir; first two sheets are made out and the applicant is 
certified there to be physically and mentally able, to the best of his 
knowledge and belief, and capable of performing his duties and a 
statement also is made with reference to his sight and hearing. 
When we send for them they come here and we have a branch ward 
of the civil service department to make an examination; our insti- 
tution has its own local board made up of its own officers. These po- 
sitions are of the non-competitive class and these officers, or their 
representatives, will actually examine these applicants, giving them 
test questions in reading, writing or arithmetic. In the competi- 
tive class the examiration is held at Albany by the civil service 
board. 



255 

Q. What class is examined? 

A. All attendants, farming, all in the culinary department. 

Q. Are the assistant physicians examined? 

A. Yes, sir; they are examined by the state board. When we 
have a vacancy in the competitive class, we have to report all 
changes as they occur and it is done right after the vacancy occurs. 
I sent in one or two to-day to the civil service board at Albany. 
If we desire positions filled from the competitive list they send 
us the names of the three highest on the list and we are compelled, 
under the law, to select from those three. 

Q. You don't get a second list from which to select? 

A. No, sir; only from that one list. 

Q. The government has a little different method. They will send 
you the second list if you fail to select from the first list but you 
must select from that second list. 

A. I am inclined to think that is a pretty good thing. If you 
handle the civil service too closely, the one trouble we find, it is 
apt to reduce the list, a list of. those only up to mediocrity and it 
keeps out those who are on the non-competitive list rather than 
the competitive list. All those who are bright and energetic want 
to go into institutions close to the large cities rather than to insti- 
tutions isolated and at a distance from them, and not being able to 
make a selection entirely of their own it may not result so well for 
the isolated institutions. Take the position of physicians, partic- 
ularly, every man will not make a good physician in this work; he 
may make a good practitioner outside but he may lack the qualifica- 
tions necessary for a position of this kind. We do not want a man 
who will settle down and be content in moving along in a rut, but 
we want progressive men with a good deal of energy and love for the 
work. 

Q. (By Mr. Bliss.) How do you discharge employes or physicians? 

A. All the employes in the state service appointed from the com- 
petitive list can be removed for cause by the appointing power. All 
employes are appointed, except the steward, by the superintendent, 
and the steward and superintendent are appointed by the Lunacy 
Commission. If he made an unfit appointment they could go in 
and discharge him and they could make an appeal. 

Q. Does the law give them a right to a hearing? 

A. Yes, sir; and the decision on that hearing is final? 

Q. Before the superintendent? 

A. Yes, sir; it does not state definitely but I have always taken 
the ground, as far as removals were concerned, that the intent of 
the civil service rules was to give the right of appeal and I would 
not suspend any man unless I did so under legal evidence that would 
stand if the appeal was made. 



256 

Q. What would you suggest as the best means of preventing 
insanity, I know it is rather a broad question? 

A. You could fill volumes on that subject. 

Q. Just in a general way ? 

A. To boil that down, to put in an entirely practical way, I don't 
know that there is any remedy that I could suggest except to teach 
people to live more natural lives, live better lives and promote better 
citizenship and make the conditions of life so there would not be 
quite as much stress as there is at the present time, as there is in 
present localities, and remove some of the causes that tend to it. 

Q. What are some of the causes? 

A. Isolated neighborhoods where they break down in the rural 
neighborhoods from the monotony of life. The fact they are not 
in touch with others and lead hermit lives until they brood over 
fancies and go to pieces. 

Q. Is alcohol one of the causes? 

A. It is one of the principal causes but it need not necessarily 
be the primary cause, as you will know a great many people take to 
alcohol because of lack of success and discouragement and trouble 
and disappointment and grief, so it is not alcohol alone that brings 
men or women into an insane asylum. If you look back you find 
that the habit of excesses and alcoholism, as between them, I might 
say that excess is more largely a factor than alcohol. You can use 
that term because it may mean so many things. It may mean get- 
ting into trouble, brooding over things and all that. 

Q. W^hat is the percentage of those w 7 ho have inherited the ten- 
dency of insanity, is it a large per cent.? 

A. No, sir; about 50 per cent. It is not as large as people usually 
think because it is a common opinion among people that insanity 
is all hereditary. This table of 1900 show T s the total of 269 cases, 
all told, and 145 men and 124 women; that is based on the number 
of admissions that year. They had tendencies of some kind that 
were traceable. It would be very hard to speak about that with 
any great degree of accuracy because we carry the collateral branches 
along. We say there is some hereditary tendency if we find a 
cousin or some other relative in the family and if you trace that 
out you might find that it was not in the direct branch at all and 
to say what the percentages would be would require very close 
study. 

Q. I see in the table showing hereditary insanity in patients ad- 
mitted since 1888 that in the total column there are 269 cases and 
there were 48 unascertained and 130 had no hereditary tendency, 
you simply put that down when they had insane relatives? 

A. That would leave about 91, the difference between 178 and 
269, about 30 per cent. 



257 

Q. The county care of the insane in your state has been abolished? 

A. Yes, sir. 

Q. Did it work unsatisfactorily? 

A. Yes, sir; I don't think I need have any hesitancy in saying 
so as it was managed in this state but I would have to give you 
a little idea how that was carried out. We had one or two county in- 
stitutions, said to be very well managed in counties with compara- 
tively small populations and of those I cannot speak except from 
hearsay; I think they were fairly well managed but not as well 
as institutions since, for the reason that they did not have the 
appropriation and did not have the population to be able to get the 
facilities they could in larger institutions without throwing an 
unfair and large expense on the counties pro rata. In New York 
and Kings county, where the largest number were cared for, I 
should think over a third of all the insane in the state, I think we 
had about a third at Manhattan, and the others must have run up 
the total very large. 

Q. I suppose in those large sections of population they would 
work out then in the country districts? 

A. They did not have to; the reason for that was this, they had 
to pay their pro rata proportion of caring for the state insane and 
the population was so large that it resulted in New York and Brook- 
lyn paying nearly 70 per cent, of the total cost of caring for all the 
insane in the state of New York. They preferred to manage their 
own hospitals in their own way rather than come into the state, 
than to get their pro rata tax for running these institutions, and 
the result was in New York that they were paying about $350,000 
for caring for their own insane to reduce the per capita cost and 
they were inclined to reduce the per capita cost to the lowest ebb 
and the result was that for years and years we never could get 
enough money to run our hospitals as they should have been; and 
we were the target all over the United States and it resulted in 
having insufficient funds and trouble from our help and considerable 
trouble on the part of the patient on account of not having enough 
money to pay our employes and employ more; and it resulted in 
investigation and so on, and at last measures were adopted to de- 
termine what it cost in comparison to state hospitals and by that 
time the state began to actively agitate this matter and people in 
New York looked into it, whether it paid them to pay this money; 
and they came to the conclusion that the state insane were 
getting better treatment than they could give them and the result 
was finally to transfer to the state asylum from Kings county and 
New York. 

Q. (By Mr. Bliss.) Had the state any care over those institutions? 
17 



258 

A. A general supervision by the Lunacy Commission but without 
any power except to make general repairs. 

Q. Do you think it is an advantage to keep the epileptics in a 
separate institution, or at least in separate wards? 

A. Where the number of epileptics is numerically large enough 
to warrant separate establishments I believe it would be better to 
separate them entirely and handle the epileptic and criminal class 
separately. Keeping the criminal class with the other insane pa- 
tients tends to give the general public an idea of a low grade place 
for incurables rather than a place which can be called a hospital? 

Q. Have you any epileptics? 

A. Insane epileptics? The state has not as yet developed their 
institution so they can take all the ordinary epileptics of the state; 
and the epileptics as a class, particularly the insane epileptics, is 
not a very promising class to handle and you cannot expect much 
else than a betterment in their condition. 

Q. The acute and chronic insane are kept in separate wards? 

A. Yes, sir. 

Q. What would you think to having institutions for the chronic 
or wards for the criminal insane? 

A. I think it would be more desirable. 

Q. Separated entirely in an institution of this kind? 

A. Yes, sir; if I could. 

Q. Would you have a separate institution entirely? 

A. If the number is large enough I would; it goes without saying 
that you can handle them as well and the moral element in it would 
be better. 

Q. What would you include of the criminal class to be admitted, 
the ones who have committed crime, or those who have attempted 
to commit crime and failed? 

A. I would place all the criminal insane in a separate institution. 

Q. (Mr. Hall.) Would you draw the lines between the convict 
insane criminals and those who committed crime because of in- 
sanity? 

A. I would say those who had been caught under criminal process 
and recognized by courts as criminal, whether tried or not because 
of having any criminal act. 

Q. (By Mr. Bliss.) Do you think it is safe to trust to the jury, 
where their sympathies are invoked by counsel in favor of men 
accused of crime because of insanity and acquit him on the ground 
of insanity, do you think you would have sufficient to take that 
judgment to warrant you in sending them to the hospital for the 
convict insane? 

A. If they are held on the order of the criminal court; those 



259 

people could be cared for in that way. It would relate lo those 
who have been convicted in this state. A person can be transferred 
who has been held on a criminal order, those who are held on crimi- 
nal orders. 

Q. That is, any one that commits crime? 

A. Yes, sir; without the necessity of completing the trial and 
recognized by the courts that they are insane. They recognize that 
by appointing a commission to inquire into it instead of going on 
and convicting the person for the crime. The sentence is supended 
and he is sent to the asylum for the convict insane and if recovery 
takes place they are returned and tried. Then the question comes 
up whether it was due to insanity or whether he was shamming. 

Q. Do you send a man of that kind direct to the hospital for the 
criminal insane? 

A. They go to the state institution, or to the criminal institu- 
tion direct, according to the order of the court; but the practice 
is to send them to the state hospital and that to be determined 
between the superintendent of the institution and the Lunacy Com- 
mission and if between them it seems to be a dangerous thing to 
maintain the person at the institution with the other patients he 
is sent to the hospital for the insane criminal. They have better 
facilities for taking care of the dangerous class there. 

Q. Would you send one, who had attempted to commit crime and 
failed in its execution, there? 

A. Not necessarily. 

Q. Would you have authority to make such transfer? 

A. I would not have any power to transfer at all. The Lunacy 
Commission would have power to do so if they thought that was the 
best place for the person. 

Q. What is the cost per capita to maintain your patients? 

A. The weekly cost, for the year ending September 30, 1901, was 
$3,061. The weekly cost for six months ending September 30, 1901, 
was $2.83. The weekly per capita for six months ending March 31, 
1902, was $3.15. The weekly per capita for the year ending March 
31, 1902, was $2,988. So you see it averages from $2.98 to $3.15. 

Q. What was included in that? 

A. Everything except extraordinary expenses, such as new build- 
ings. 

Q. Salaries? 

A. Yes, sir. 

Q. Betterments? 

A. No, sir; all ordinary repairs and all salaries, wages and sup- 
plies. 

Q. What is the percentage of cures in an institution of this kind? 



260 

A. That is influenced very largely by transfers and matters of 
that kind. In this state we have to meet the overcrowded condi- 
tion of the institutions; we have transferred around from one insti- 
tution to the other and for the year ending September 30, 1901, the 
percentage and the number of admissions was 19.6 per cent.; it runs 
from 19 to 24 per cent, of the admissions. 

Q. About what percentage have been discharged as cured that 
return again? 

A. It is all a matter of record in these tables (referring to tables 
in annual report). 

Q. That is in your report? 

A. Yes, sir. 

Q. How often do the relatives visit patients in this institution? 

A. Some visit them very regularly. It depends very much on the 
convenience or nearness of the friends to the institution; we have 
a woman patient here, to whom my attention has been called, who 
has been here forty years and the husband has regularly visited 
that patient every year in that time and has come here two or three 
days once a year. 

Q. What is your classification of the insane? 

A. That is also given here in this report. 

Q. How many insane patients do you think can be advantageously 
cared for in a single institution, say in the care of the insane where 
money is not a consideration? 

A. If money was not a consideration I should say that it would 
be wise to limit it to a thousand patients, rather less than that than 
more, but as applied to the public service. 

Q. All the advantages could be obtained in an institution of a 
thousand patients? 

A. Yes, sir; where money is, as it usually is in public service, 
always scarce. 

Q. How would you divide the insane, would you have the chronic 
insane in one institution and the epileptics in another institution 
and the criminal insane in another? 

A. I would have the criminal insane in one institution and the 
epiJeptics by themselves, either the insane epileptics with the insane 
or epileptics in a separate ward, and of the acute and chronic I 
would prefer to have them at one institution, built up on something 
like the cottage plan. 

Q. (By Mr. Hall.) Assuming that an institution of this capacity, 
2,200, is practicable and advantageous from both a medical and 
the business sides of the proposition and you had the authority 
and the funds at your disposal for the construction of a hospital of 
like capacity, how would you build it, on what plan as to con- 






261 

tiguity and connection to the several departments, so as to best 
secure its efficient and economical management and a proper classi- 
fication of patients and what do you consider a proper classification? 

A. Well, as to the division of the buildings I think I would 
follow a division somewhat similar to what you find in this hos- 
pital, based very similarly on what you find in the other mixed hos- 
pitals, having a department for the acute, hospital wards, detached 
wards for acute mania and group my buildings as far as I could 
so as to divide up the population into segments and provide for 
classification of the chronic and acute, dormitory wards for your 
chronic cases without the necessity of having single rooms all to- 
gether but with sufficient number of single rooms, ranging 
from ten to twenty per cent., and a separation of those who became 
violent or noisy among the chronic cases. There are some who are 
among them that will become excited and need temporary care tha*" 
they do not need in the acute cases. I would also have the dining 
room and kitchen service and buildings brought closer together 
without too wide a separation to allow economical heating. There 
are different plans in which you could arrange your buildings; you 
could place them on a rectangular plan, that would be as the 
architect would provide. If you separate them too widely you have 
to have separate kitchens for all your buildings. I would bring 
them together and make your grounds attractive rather than have 
them the appearance of a prison. You can distribute your food 
from one building and one kitchen in this way, where otherwise you 
would require a number of kitchens and in the same way you can 
bring your patients to a common dining room from all those build- 
ings rather than to a number of dining rooms. If you do not have 
your buildings too widely separated from each other you can heat 
them much better and more economically. 

Q. Are not some of your buildings too far away here? 

A. Yes, sir; I think so. 

Q. Would you say that a plan of buildings connected by corri- 
dors would be of the greatest advantage? 

A. Yes, sir; but not necessarily. I would have them arranged 
so as to allow the noisy and disturbed cases separated from the 
quiet and particularly from my convalescents. 

Q. (By Mr. Bliss.) Where would you put your convalescents? 

A. I would put them as near to my administration building as 
possible. 

Q. Do you think it would be necessary to have them removed 
as far as possible from the disturbed buildings? 

A. Not necessarily; I would have them separated. In my gen- 
eral group of the buildings my method would be to remove them from 
the effect of the majority of the patients of the hospital and that 



262 

of course, if you had plenty of funds, would be feasible in every way. 

Q. (By Mr. Hall.) You would like to have such departments that 
you could separate the acute and chronic as nearly alike in their 
mental and physical condition and put those who are nearly alike 
in their mental and physical condition by themselves? 

A. I would have a division of the wards and a sufficient number of 
buildings so you could separate these people and classify them ac- 
cording to their mental and physical condition. 

Q. And send them to a general kitchen? 

A. Yes, sir. 

Q. At Warren they have a convalescent building that will hold 
about fifteen and they take them there w T hen they are convalescent. 

A. If you have a large hospital property it is entirely feasible 
to have a colony to separate those people so as to give them indi- 
vidual life and I think that is a very desirable thing to do, but 
taking care of them under general hospital management it does not 
separate the general hospital management or organization. 

Q. (By Mr. Bliss.) Can you tell how much money is invested in 
this property as it stands, machinery, etc.? 

A. I cannot tell you accurately but the estimated value of the 
property and real estate is based partly on the figures; and cost of 
construction of the original building was $1,396,243.50 to the time 
of making this report. 

Q. Have you any opinion whether that sum of money would build 
a hospital on the lines you have indicated, with one central heating 
apparatus and one central kitchen? 

A. No, sir; I could not answer that off hand without making a 
calculation and taking an architect into consultation. It is so long 
since I have gone over figures of that kind that I would not like 
to make a statement at this time. We have found we could erect 
our buildings and furnish them at a per capita cost of $500, includ- 
ing bed, and that would meet all expenses except sewerage and 
power plants and light plants. It would wire the buildings and 
pipe them, furnish the steam radiators, but we found when we put 
in the added cost of the steam engineering department, that that 
run up the cost. It depends largely on location and how far you 
are going to carry your steam and the lay of your land and whether 
you have a natural outlet for your sewerage, or whether it will 
take care of itself and other matters enter into it; and the tendency 
now is even to reduce the cost somewhat. I think they have re- 
duced the per capita in the later buildings about one hundred dollars 
but I think it is done by reducing the construction of the building 
in running the stories up to three instead of two. I am inclined to 
believe it is a good thing to have two stories for the clean class 
and the third story for the filthy class. It is almost impossible to 



263 

^et fire-proof buildings these days because of the cost of construc- 
tion. So, you see, your construction is really on a mixed system: 
Three, two and one story buildings. 

Q. Do you care to give us any expression of opinion as to whether 
your system of purchasing supplies for all state institutions and 
furnishing them from a central source is beneficial or not? 

A. I do not believe in iron clad systems but I think it is desirable 
to follow some such system as we have in this state. We think 
we can get better prices by making joint contracts; I think it is 
desirable but I think there should be some flexibility about it so 
as to get out of it when it is not advantageous. We went into 
this joint contract business and we had one commissioner who 
thought all supplies ought to be bought on joint contract and we 
found in some localities that some hospitals could get better rates 
for certain articles than could be obtained in that way. For in- 
stance, we found here we could get beans, potatoes, hay and straw 
at better prices* than through the joint contract and being near 
Geneva and having our own barge we could do better in the pur- 
chase of salt. They were paying $1.50 a barrel by joint contract for 
salt; I protested against that because I had a quotation of 85 cents 
a barrel at Watkins and we sent our men there and we were enabled 
to get salt at 85 cents F. O. B. at Watkins; and the last purchase we 
made we purchased 100 barrels, which was only a short time ago, 
and the Commission took no exception to it. They said that is a 
matter of common sense and if you can show you can buy very much 
better the best thing to do is to let you out of the contract. But T 
think wherever the purchases can be bought in large quantities it 
is advisable to have a joint purchase; it has worked well in this 
state as far as our experience goes. In the New York hospital, 
when I was there, w r e bought all our supplies, but our institutions 
were so large that the institutions for the insane could do just as 
well as the other institutions of the other departments. We paid 
60 cents a barrel F. O. B. at Watkins and $2 a ton for our agricul- 
tural salt. 

Q. Do you care to give any expression of opinion as to the in- 
fluence, beneficial or otherwise, of your system of periodical meetings 
of superintendents? 

A. I think it has been a very beneficial thing for us to come to- 
gether and exchange ideas and compare notes. 

Q. Is it required by law? 

A. It has been up until the present and now it is left to the option 
of the Lunacy Commission. They can call on us on notice at 
any time and there is no restriction as to the number of times, once 
a year or twice a month. When we met once a month, some of us 



264 

being at arms length from Albany, it seemed to be very well and 
then it was decided to meet twice a month and I thought it was of 
a little disadvantage, as it generally took me two or three days time 
away from the institution. 

Q. What is the general scope and power of this Lunacy Commis- 
sion over state institutions, over you for instance? 

A. They have full power to direct the management of these insti- 
tutions according to their rules and regulations. 

Q. They appoint the superintendent? 

A. Yes, sir; and steward. 

Q. Can they discharge them? 

A. Yes, sir; and they have an opportunity to be heard by them. 
I think that necessarily includes, under the rulings, that there has 
been no such cause. I think it would be the same as regards any 
removal by the superintendent. 

Q. Do they take the place of the local boards of managers? 

A. Yes, sir; we have a board of visitors with reportorial functions 
appointed by the Governor and removal at will. 

Q. How long has that system been in effect? 

A. The new system? 

Q. Yes, sir. 

A. From the 1st of April, this year. 

Q. (By Mr. Hall.) Have you visited all the other insane asylums 
in this state? 

A. Yes, sir; all but one. 

Q. And there are fourteen? 

A. I would have to count them up. 

Q. Do the the other superintendents come here? 

A. Occasionally. 

Q. It is the practice among the superintendents to occasionally 
go to the others? 

A. Yes, sir. 

Q. We found some of ours who had not been in any other asylums 
in our state? 

A. I think they ought to have latitude not only to visit the institu- 
tions of their own state but those in other states. Generally speak- 
ing, all of the superintendents of the country are members of the 
American Medical Physiological Association, that has a meeting 
once a year and a large number of superintendents of all the states 
and Canada attend those meetings. In case they meet in Canada 
they allow only so many to attend each year but in those cases 
their expenses are met by the state which sends them and their 
expenses are only nominal, five dollars or something like that. This 
year our meeting is at Montreal on the 17th of June. We have an 



265 

elaborate series of papers and we stay long enough to compare notes 
and make plans for visiting institutions where there is any progres 
sive lines of work going on. 

Q. What salaries do you pay your nurses? 

A. We have a graded list. Our men draw, as a minimum, twenty 
dollars*; and it runs to twenty-four dollars. 

Q. Are the female nurses paid the same? 

A. The men are paid from twenty to twenty-four dollars; the 
women from fourteen to eighteen dollars. The attendants in charge 
of wards run from twenty-five dollars to thirty dollars for the men 
and for the women it runs from twenty to twenty-five dollars. 
Graduate attendants are paid more; they are called nurses and we 
give them a two years' course. They can take a post-graduate 
course afterwards where special instruction, etc., is given them, 
and after they graduate we pay them twenty-five to thirty dollars, 
that is, the ordinary nurse. Where he is a charge attendant or ward 
attendant we pay the men twenty-five to thirty dollars and the 
women twenty to twenty-five dollars. Then after graduating we 
pay the men twenty-eight dollars to thirty-three dollars if he has 
charge of a ward and the women twenty-three dollars to twenty- 
eight dollars. 

Q. That is three dollars more than the charge attendants? 

A. Yes, sir. 

Q. The charge graduate attendant gets more than the attendants? 

A. Yes, sir. 

Q. And the charge nurse gets three dollars more than the charge 
attendant? 

A. Yes, sir; and gets, as a minimum, eight dollars more than the 
attendant. We have a classified wage list and salary list now for 
all institutions of all the departments in the state of New York, but 
that state department of the insane is separate from the other. 

Q. (By Mr. Bliss.) Your civil service could hardly be enforced 
if there were no central board in existence, you could hardly con- 
duct it yourself? 

A. I don't know why it could not be done in that way; you 
might say that virtually we make our own appointments to depart- 
ments ourselves. All the papers have to be filed with the central 
board, where they can be looked over and criticised as to whether 
there is a sufficient test for these positions, etc., and in that way 
it works very well. I am inclined to think that our system would 
be better if it was a little more flexible; and it would be of advantage 
if a larger number of physicians were added to the list, because there 
are special occasions in an institution where the medical faculty 
of an institution would better understand the wants of an institu- 



266 

tion than an outside board and for the reason that it is not likely 
that those outside can make as wise a selection as those who are 
right on the ground. 

Mr. Snyder. Dr. Murdoch, have you any questions to ask? 

Dr. Murdoch. No, sir. 

Q. (By Mr. Hall.) Do you think it advisable that every institu- 
tion of this kind should have separate quarters for the nurses where 
they could be away from their duties when not on duty? 

A. Yes, sir; I do. I think it is a very desirable thing within 
reason. However, I would say, it would be necessary to have a 
certain number on the wards in case of accident, fire, or a patient 
becoming violent; that can be determined by the head of the insti- 
tution. For the remainder and other employes I think it is infinitely 
better to have them outside. We have found it of great benefit 
here to have a number of employes live outside and a row of build- 
ings was pointed out where many of them live. They are close 
at hand. I would prefer to have them a little further away. They 
can have small homes of their own and in that way will be more 
apt to stay with us and settle down. It is natural for the oppo- 
site sexes to come together and form affinities. Most of our insti- 
tutions allow their employes to mingle together and supply quarters 
for married people without children. I think it is very desirable 
to take them off the wards after their work is done and have some 
place where they can have rest and relaxation and be removed from 
the sights and scenes of the day's work. I don't think anything 
will give a higher degree of efficiency on the part of employes to 
treat all of them in a humanitarian way and not treat them like 
machines because when you treat them like machines they will work 
like machines. 

Q. (By Mr. Snyder.) How many assistant physicians have you? 

A. Ten. 

Q. How many females? 

A. One woman physician. 



LEGISLATIVE COMMISSION TO INQUIRE INTO THE CONDI- 
TION OF PENNSYLVANIA INSANE. 



Inspection of the Manhattan 
State Hospital on Wards Is- 
land, New York. 



JUNE 28, 1902 



(267) 






(268) 



INSPECTION OF THE MANHATTAN STATE HOSPITAL ON 
WARDS ISLAND, NEW YORK, JUNE 28, 1902. 



The Legislative Commission to investigate the condition of the 
insane visited the Manhattan State Hospital of New York, sit- 
uated on Wards Island, on June 28th, and were met by W. L. Park- 
hurst, commissioner; T. E. McGarr, secretary of State Lunacy Com- 
mission, and E. C. Dent, M. D., superintendent of West Side Hos- 
pital. This hospital is entirely devoted to women. 

The superintendent took the committee in charge and showed 
them through the various chronic and acute wards in the West Side 
Hospital. 

This hospital is conducted on the cottage system. The buildings 
are two stories in height, well lighted and ventilated, with central 
kitchen, where all the food for the institution is prepared and taken 
through corridors to the different buildings and wards. The kitchen 
is superintended by a woman chef, who has full charge of all the 
culinary department. 

There are at this hospital 2,127 women patients, of which 80 per 
cent, work at sewing fancy work, weeding the grass and making 
clothes for the patients. Each patient i® supplied with clothes 
made to measure, and fitted and marked by number, so that the 
inmates always have the same clothing returned to them after being 
cleaned. The patients also pick over the hair that is used in the 
mattresses. This is done by those who are not physically able to 
do any other work. 

The acute insane are treated in a separate building. In this 
building also all patients are received, and primarily treated, and 
after a short stay in this ward are distributed to the different wards 
according to the nature of their diseases. The wards are so planned 
that the attendants have perfect supervision over all the patients. 
It was stated by Dr. Dent that 23 per cent, of the acute patients 
recover. In this institution they have tried the color treatment, 
that is, have rooms fitted up and painted in one color. (Primary 
colors are the only ones used.) This is for special nervous cases, but 
the effect produced thus far has not been very noticeable. The 
number of attendants to patients is one to ten. The attendants are 
all women, but only one woman physician, the rest are males. 

In this institution the spray bath system is used, This is in 

(269) 



270 

charge of a special attendant, who has full charge of regulating the 
temperature of the water and no one could possibly get injured by 
the use of water being too hot, and no careless attendant can bathe 
two or more patients in the same w^ater. 

In the receiving ward there is an operating room equipped for 
all emergencies. It w r as stated that the cost of maintenance at this 
hospital is 40 cents per day, or $2.80 per w 7 eek. 

After making a full inspection of this division of the hospital 
the Commission w T ere turned over to the superintendent of the East 
Side, A. E. MacDonald, M. D. This hospital, formerly known as 
the New York City Asylum, and now knowm as the Manhattan 
State Hospital East, situated on Wards Island, is entirely devoted 
to male patients and is separated by a high board fence from the 
West Side. This hospital is one of the old insane hospitals built 
about thirty years ago, and more on the congregate style, and four 
stories in height, w T hen expensive buildings w T ere in order. 

The per capita cost of this building w r as about $1,500, while the 
West Side Hospital was about $400 per patient. 

This hospital contains about 1,900 male patients, but only about 
50 per cent, are able to work. They are employed on the farm and 
in shoe shops and printing office, etc., as this institution does the 
printing for the rest of the state hospitals. The furnishings of 
the hospitals are all made in the state prisons. After a patient 
recovers sufficiently they try to find out w T hat class of work or trade 
he originally followed and then place him at the same business. 

The Commission visited the various w-ards of this hospital. The 
patients are fed in the various wards about the building by food 
w 7 hich is supplied from a central kitchen. The acute cases here 
receive practically the same treatment as in the other state hos- 
pitals. 

It w r as noticed at this institution that some of the w r orst class of 
patients (that is the filthy patients) not able to look after or take care 
of themselves, are kept in tents the best part of the year. This, 
of course, adds to the health of the rest of the patients in the hos- 
pital. Some of the consumptive patients w^ere maintained in the 
same manner during a portion of the year, the tents being heated by 
stoves and lighted by electric lights. The patients seemed to thrive 
under this treatment. 

The cost of maintenance at this branch of the Manhattan State 
Hospital is over $3.00 per capita per week. 



LEGISLATIVE COMMISSION TO INQUIRE INTO THE CONDI 
TION OF PENNSYLVANIA INSANE. 



Inspection of State Hospital for the Insane 
at Norristown. 



JULY 12th, 1902. 



(271) 




(272) 



INSPECTION OF STATE HOSPITAL FOR THE INSANE AT 
NORRISTOWN, JULY 12, 1902. 



The Commission to investigate the condition of the insane, visited 
the State Hospital for the Insane at Norristown on Saturday, July 
12, 1902, and was received by the president, Joseph Thomas, M. D., 
Dr. G. M. Stiles, Samuel K. Anders, directors of the institution; 
Dr. D. D. Richardson, chief physician of the men's department; Dr. 
Mary M. Wolf, chief physician of the women's department, and 
John L. West, steward. 

The Commission, under the guidance of Mr. West, visited the din- 
ing rooms in both the male and female departments. There were 
about six hundred male and female patients at dinner in separate 
dining rooms. The rooms were well lighted and ventilated. It 
was stated by Dr. Richardson that the patients working on the 
farm, etc., were fed outside, so that they would not have to change 
their clothing at the noon hour. 

The store room was next visited. From here the full supplies for 
the hospital are distributed by requisition to the several depart- 
ments of the hospital. 

The cold storage plant and then the bake house were next visited. 
The ovens are modern, heated by coal and always ready for use. 
The machinery in this building is sufficiently large for all the work 
required. 

The new buildings, containing the violent wards, were next in- 
spected. These are built on a modified cottage system. They are 
two stories in height, and in these were found all classes of insane 
mixed together in the wards. The hospital is so crowded that it 
is impossible to separate to any great extent, the criminal insane 
being with the rest. Some restraint, however, is used in cases where 
murderous mania prevails. In these wards were noticed imbecile 
children, that should have been at some other institution where 
proper facilities exist for treating; and educating such class of pa- 
tients, such as at Elwyn and Polk institutions. 

The usual percentage of acute and epileptics prevails at this in- 
stitution, with about the same percentage of cures. 

According to the opinion of both Drs. Richardson and Wolf, the 
criminal insane should be kept in a separate wing or ward of a peni- 

(273) 
18 



274 

tentiary, and should not be sent to the insane asylums of the State, 
to mingle with the other classes of patients, as is the present custom. 

Epileptics should be kept in separate hospitals, but the chronic 
insane should never be separated, as from this class of patients the 
best work is obtained, which very materially reduces the cost of 
maintenance. 

The only fault the doctors of this institution expressed with the 
county care act is that unless the several boards of directors of the 
county institutions are very strict in the enforcement of the rules 
governing such institutions, the hospitals will be very apt to de- 
teriorate, and get back to the old almshouse standard. 

In their opinion a system could be established where eight hun- 
dred to one thousand patients could be provided for in a contiguous 
district, consisting of a number of counties, such as our judicial 
districts. This would, with proper supervision, be the same as a 
small State hospital. 

Dr. Richardson believes that all patients should be taken care of 
in State hospitals. Dr. Wolf agrees with Dr. Richardson in this 
opinion. 

In answer to the question, "Suppose money was of no considera- 
tion, how would you build a hospital," Dr. Richardson replied that 
in his opinion, hospitals should be extended in size and not increased 
in number. The capacity for each should be about 5,000 patients. 
Dr. Wolf agrees with him in this, with the exception of not placing 
any limit on the number of inmates. 

It was stated by both superintendents that about forty-five per 
cent, of the patients worked. 

The Commission then visited the women's department with Dr. 
Wolf. They entered the violent wards and found the same condi- 
tions existing as in the men's — imbecile children mixed with the 
other patients. It was here that it was noticed the lack of facili- 
ties for the attendants and nurses while off duty, as no provision 
has been made to have them sleep elsewhere, and by the overcrowded 
condition they are compelled to sleep in the wards while off duty, 
thus occupying space that could be used by the patients. 

According to Dr. Wolf, this institution while possibly one of the 
best managed in the State, does not seem to be on a par with insti- 
tutions in the state of New York, where many facilities to alleviate 
and cure disease are at hand. At this institution an operating room 
and other suitable appliances for treatment are lacking. 

The female infirmary wards were visited. Here acute and all 
classes of cases are treated. The men's department contains a sim- 
ilar ward with the same conditions. 

The Commission next visited the stables and farm buildings, and 



275 

then a separate building for the consumptive patients. This is a 
small structure, used for men, and is separated from the main build- 
ing, and was built and completed at a cost of |5,000. It will accom- 
modate fifty beds. It was stated by Dr. Wolf that the decrease in 
the death rate for consumption since the establishment of this 
building is about 50 per cent. 

The same condition prevails on the women's side, with the excep- 
tion of not having a new building erected for the purpose, but having 
in use an old building which has been thoroughly cleaned and re- 
modeled for the purpose. 

The water supply is plenty and of excellent quality. 




(276) 



LEGISLATIVE COMMISSION TO INQUIRE INTO THE CONDI 
TION OF PENNSYLVANIA INSANE. 



Inspection of State Asylum for the Chronic 
Insane at Wernersville, Pa. 



JULY 26th, 1902 



(277) 




(278) 



INSPECTION" OP STATE ASYLUM FOR THE CHRONIC INSANE 
AT WERNERSVILLE, PA., JULY 26, 1902. 



The Commission arrived at South Mountain station, near Wer- 
nersville, Pa., on Saturday, July 26, 1902, at 10.32 A. M., via the 
Lebanon Valley Railroad and were met at the station by Dr. ,S. S. 
Hill, superintendent of the institution; Messrs. Jacob M. Shenk, 
Joseph L. Lemberger and Thomas C. Zimmerman, members of the 
board of trustees. The Commission was taken by carriages to the 
main building and shown the offices, rooms, &c, after which they 
met in the trustees' room and the testimony of Dr. S. S. Hill was 
heard. In the afternoon a general inspection of the grounds and 
buildings were made, which included a visit to the reservoirs which 
supply the institution with water, the largest being ten feet deep 
aud having a capacity of fifty-five thousand gallons. The water is 
supplied by means of the gravity system and has a fall of 125 feet 
from the bottom of the basin to the buildings, it being pure moun- 
tain spring water. Other small catch basins were examined in the 
vicinity, the largest having a depth of ten feet. It was stated that 
the pressure was sufficient to throw the water over the second 
story, the buildings all being two stories in height. It was stated 
that the institution did not own the land to the top of the mountain, 
a fact which was sometimes found inconvenient for the reason that 
they became trespassers if they attempted to keep the stream clean 
beyond their own lines unless otherwise permitted by the adjacent 
owners. It is the desire of the institution to become the owners 
of about two hundred acres of mountain land, which can be pur- 
chased for about five thousand dollars, and thus enable them to keep 
the streams clean by the removal of leaves, brush and other obstruc- 
tions which stagnates the water. In the vicinity of the basins, or 
reservoirs, it was observed that a great deal of labor had been per- 
formed, by the inmates, in the building of stone walls and rip-rap- 
ping the bottoms of streams with stone, the object being to preserve 
the banks in their original state as much as possible. In the trip 
to the reservoir many inmates were seen at work in making a new 
road a short distance from the old one along the hillside in order 
to get away from the bottom lands and thus avoid frequent repairs 
after freshets. They were also seen at other various kinds of em- 
ployment as the Commission were taken from place to place. 

(279) 



280 

With regard to the hours of work, the inmates rise at 5 o'clock, 
the men workmen being divided into squads of fifteen, and some 
being sent out at 7 o'clock and others at 9 o'clock, the latter remain- 
ing in the buildings to do work in and about the premises. They 
remain out until 11 o'clock. In the afternoon they begin work at 
1 o'clock and quit at 5 o'clock. After returning from their work 
they go to the wash room, wash and take off their shoes and work- 
ing clothes. It was also stated that the men were not forced to 
work but most of them preferred it and very little trouble was 
experienced in that respect. Roads, lawns and other improvements 
were pointed out as being wholly constructed by the patients. In 
these roads, lawns, gardens, orchards, berry patches, all summer 
crops, appeared to be in excellent condition. In the garden and 
truck patches all kinds of vegetables are raised. 

The grounds consist of 550 acres, about 300 of which are under cul- 
tivation. The Commission were taken to the barn, piggery, hennery, 
root building and other buildings. An old mill was pointed out 
which is being utilized exclusively for the benefit of the institution. 
There are on the premises, belonging to the institution, 38 head of 
horses and mules and about 50 cows. 

The Commission were shown through the women's sewing room, 
dormitories, women's day room and men's day room, and were con- 
ducted through the dining room while the inmates were at dinner. 
They also visited Amusement Hall, which has a capacity of seating 
one thousand persons. A weekly dance is given and this is varied 
by having band concerts, minstrel shows and exhibitions of stereop 
tican views. These entertainments appear to be very much en- 
joyed by the patients. 

The Commission also were shown the cold storage and refriger- 
ating plant, electric power plant, bake shop and laundry., Fifteen 
thousand pieces are run through the laundry every week; in connec- 
tion with this work steam dryers are utilized as well as electric 
irons. In the bake shop between 5,500 and 6,000 loaves of bread 
are baked every week, representing 22 barrels of flour of 280 pounds 
per barrel; there is consumed about 800 loaves of bread per day; if 
it is fresh bread it takes about 1,000 loaves. Inmates wait on the 
table and assist in everything possible. They make straw hats, 
brushes, mattresses, clothing and underclothing. In the manufac- 
ture of brushes they have a surplus and it is disposed to a sub- 
contractor. Their brushes very often pass a better inspection than 
those made by a regular manufacturing plant. 

A hose carriage is kept at each building, located near a fire plug 
and these are manipulated when necessary by inmates of the insti- 
tution. Very often a bonfire is built in order to give the patients 



281 

an opportunity to practice the use of the hose in connection with a 

fire. 

The greenhouses, which furnish flowers and plants for the adorn- 
ment of rooms, corridors, dormitories and the lawns, are under 
the supervision of John W. Elliott, a patient of the institution, 
assisted by other patients. A hedge fence was seen on both sides 
of the main walk from the main building to the station. John W. 
Elliott is from Washington county and a graduate of Washington 
and Jefferson College; he afterwards attended the Theological Sem- 
inary at Princeton and because of over study his reason failed him. 
A brief sketch of his peculiarities was given by the superintendent 
as illustrating certain phases of insanity. "He is allowed to take 
occasional trips. On one of these he visited some of the greenhouses 
in Norristown and Philadelphia in order to learn the names of some 
flowers and plants. When he got to Princeton some of the foot 
ball players were going over to New York and he went along and 
staid two days and told me about it when he came back. We had 
some plants presented to us by the Colemans and he did not know 
the names and whilst at New York he went out to Bronx to look 
up the technical names of some of these plants. He teaches a class 
in Sunday school and no one knows his lesson better than he does. 
He has no hallucination or delusion, just a little bit off. He is 
very nervous and incoherent at times; for instance sometimes he 
will engage in a conversation and break off in the midst of the con- 
versation and move off. He is moody at times, one day he is very 
pleasaut and the next day may be very moody. He would not be 
safe to let out entirely alone; we have to watch him and see that 
he keeps his clothes on. He was first committed to Dixmont and 
I believe he was violent then, but now he is happy and contented 
at his work. If he was permanently outside he might become trou- 
blesome. We have a number of patients here who get along very 
well but if they were outside they would become very troublesome 
because here they are kept at work as much as possible and they 
feel that they have the surveillance of the institution over them." 

"We have," said the superintendent, "a colored man here by the 
name of John Craig, who was a very good workman and did good 
work in connection with farming, until one of his friends came here 
and told him that he did not need to work. Since that time it has 
been very difficult to get him to do anything. He receives a pension 
of |75 each quarter and has a deposit in the Lancaster Bank of 
about |15,000. 

"We have an outside watchman and inside watchman and regu- 
late their movements by a clock in one of the corridors. We have 
a woman in the women's ward and a man in the men's ward and 



282 

they go on duty at 8 or 8.30 o'clock in the evening and we have 
stations that they wind up, at stated times. We make use of a 
magnetto to for this purpose and have a sheet which is punctured and 
we see in the morning whether they have been through the wards 
at the time they should have been and in that way we keep con- 
stant surveillance over the patients. In some parts of our building 
we send watchmen through the wards every hour (and in some parts 
every half hour). When we find it would be a disturbance to the 
patients we do not have them go through so often. We have a sys- 
tem by which they, the watchmen, must ring up at stated intervals. '- 

Mr. Snyder. There is no concerted action among the patients? 

Dr. Hill. No, sir; if that were true we could not send them out 
in squads of fifteen because if one would rebel and the attendant 
was giving him attention the other fourteen would walk away. 
Some of them will turn in and assist the attendant in case of any 
trouble. 

The Commission also visited the filtering plant for the disposal 
of the sewage from the buildings. The filtering plant is located 
about fifteen hundred feet from the buildings, into which all the 
sewage is conducted through pipes and by means of filtration 
every particle of human excrement disappears. The water is 
pumped to various parts of the farm and water plugs are located at 
different places through the fields and utilized for the purpose of its 
distribution as a fertilizer. Dr. Hill explained that it furnished 
a splendid fertilizer and was the safest and most convenient manner 
in which to dispose of the sewage. No smell existed in the vicinity 
of the filtering plant. It was stated that the Waring system had 
been adopted originally by the institution but it was found not to 
work satisfactorily and its use was abandoned. 

The lime kilns and quarries were visited and their utility was 
fully explained, in the operation of the farm, in connection with the 
labor of the patients. 

A formal meeting of the Commission was held, at which the fol- 
lowing testimony was taken: 

Dr. S. S. Hill called and examined by Mr. Snyder, Chairman. 

Q. Have you anything to suggest for the improvement of the laws 
in institutions for the treatment of the insane? 

A. I do not know that I could volunteer any suggestion. 

Q. What is the cost of maintenance of patients in this institu- 
tion? 

A. It runs about $2.96 per week per capita. 

Q. What percentage of cures do you have? 

A. Well, we cannot say we have any percentage of cures. We 
have the care of the chronic insane here and we discharge some 



283 

sufficiently improved to go home to their friends but even in those 
cases we cannot say they are permanently cured. 

Q. They are only paroled? 

A. Yes, sir; they are all cases of long standing, one to twenty 
years. 

Q. You don't receive any cases except those of the chronic in- 
sane? 

A. That is all. 

Q. Please give us an idea of the line between the chronic insane 
and other forms of insane persons; in other words, what goes to 
make up your diagnosis of a chronic insane person? 

A. I believe to start out with that I will say that the act of 
Assembly incorporating this institution provides that we shall not 
receive cases here which have not existed for less than a year. 
Of course that is an arbitrary ruling; we cannot say that a man 
or woman is in a chronic condition in a year and the distinction 
must be made differently in different cases. But I should say that 
when we find that the delusions have become fixed, in cases of in- 
sanity, and cannot be removed from the mind of the insane person 
we call that case chronic. We cannot make a definite time, 'Senator, 
we cannot make any arbitrary rule. 

Q. Some persons might be insane for five years and still hope for 
their recovery? 

A. Yes, sir; but it is not often the case. 

Q. If there is a chance for improvement it usually occurs in a 
year, or less time? 

A. I think so. 

Q. But there are cases that cannot recover? 

A. Yes, sir. 

Q. Do you have any cases in your institution that have perma- 
nently recovered? 

A. I do not think so. 

Q. Do you have any idiots or imbeciles? 

A. Yes, sir; we have. 

Q. Do you think they ought to be in your institution? 

A. Well, I don't think so. 

Q. Should they not be in an institution for the feeble-minded? 

A. Yes, sir; however, the cases we have are not recoverable cases 
and perhaps they are as well taken care of here as in other insti- 
tutions. Our cases of feeble-minded, we have, are congenital cases 
and not recoverable. 

Q. Is their influence over the other patients bad in many respects? 

A. Yes, sir; in many respects. 

Q. Your judgment is that they should be placed in institutions 
maintained for feeble-minded persons? 



284 

A. Yes, sir. 

Dr. Lemberger. I think, under the law establishing this institu- 
tion, it was not intended that that class of patients should be kept 
here. 

Dr. Hill. Another class are the epileptic patients. 

Q. How many of those have you here? 

A. Half a dozen. 

Q. Should they be here? 

A. No, sir; they should not be among the insane. 

Q. Should they not be in an institution where only epileptic 
cases are maintained? 

A. Yes, sir; I am of the opinion that the epileptic should be in an 
institution for epileptics. 

Q. Have you any criminal insane here? 

A. We have none here with the history of having committed any 
criminal act. 

Q. Where do you draw the line on the criminal cases, the same 
as a person who has committed a crime and been convicted? 

A. Y r es, sir. 

Q. That is the legal meaning of the criminal insane but are 
there not persons who have attempted to commit crime and been 
held up and would have been as much a criminal had he not been 
prevented from the commission of it? 

A. Y r es, they possessed the criminal intent. 

Q. For instance, in Warren, there is a man who dug a grave in 
the cellar to bury his wife, and was waiting at the door with an. 
axe for his wife to come home, intending to kill her, but some one 
discovered him in time to prevent it? 

A. We have a case now that agrees with your description; he did 
not succeed in committing the crime but had the intent to do so. 
We have that man with us. 

Q. That was the history of this case at Warren? 

A. Yes, sir. 

Q. Do you think those persons ought to be placed in an asylum 
or institution specially provided for the criminal insane? 

A. Y^es, sir; I do. 

Q. Where there is bona fide evidence that they would have com- 
mitted crime if they had had a little more opportunity than that 
presented? 

A. Yes, sir. 

Q. Doctor, what per cent, of your cases are attributable to 
syphilis? 

A. I cannot give you that per cent., but very small, and I cannot 
give it because we get a very meagre history of the cases. We get 



285 

our cases sometimes from other institutions and many of the fami- 
lies of the patients do not visit their relatives here, in fact but a 
small percentage. 

Q. How about alcoholism? 

A. There is a pretty large percentage that is attributable to alco- 
holism, that is, it figures in it. 

Q. An acute nervous disease, I suppose that helps in the early 
stages? 

A. Yes, sir; heredity is a permanent factor. 

Q. Is that the most permanent factor? 

A. I think it is. 

Q. Have you ever made a study of the system of contracting or 
boarding patients out, similar to the system practiced in Belgium? 

A. In a very small way, in giving a man control of a man who 
has no friends and who would take care of him and accept the 
responsibilty of caring for him. We have sent' one or two pa- 
tients out to neighboring farmers to give them control of the patient 
and see whether he could get along in the outside world. We have 
attempted that in a few cases with fairly good results. 

Q. What is your opinion of separate county institutions, such 
as Chester county and the like? 

A. I am not in favor of caring for the insane in county institu- 
tions. 

Q. Do you think they can have as good care as where there is a 
larger institution, so far as amusement, restriction and such things 
are concerned? 

A. I don't think they will do as well for them as they do in State 
institutions. 

Q. Suppose three or four counties went together by mutal agree- 
ment and erected a hospital, would that be of any advantage, where 
they could have four or five hundred patients? 

A. I should think so, yes, sir. 

Q. Now, doctor, of course your institution is somewhat different 
from the rest, yet do you classify here, do you have the different 
grades of insanity in separate wards? 

A. No, sir; we don't classify in that way; we have dormitories. 

Q. You have all in one class? 

A. Very largely, yes, sir. We classify them as well as we can 
but we cannot do it successfully. 

Q. You cannot do it like a general insane hospital, such as Nor- 
ristown, or Warren, and places of like character? 

A. No, sir. 

Q. In regard to the question of food, can you make any sugges- 
tion, over your present regulations here, so far as the supplies and 
quality of food is concerned? 



286 

A. No, sir. 

Q. How do you get your supplies for the use of the hospital? 

A. By contract; we buy every quarter. We send out blank speci- 
fications to various people the month before the time for bidding. 
For instance, we will send out about the first of September the 
blanks for the contract to be made for supplies for the quarter be- 
ginning October 1st, and we do it in that way throughout the year. 

Q. What method have you adopted for obtaining employes? 

A. We have an application blank with specifications in reference 
to the requirements and when a man applies here this printed blank 
is sent to him with the request that he presents it in person so a 
personal interview may be had with him and his name is put on 
the waiting list and we require him to give references and make 
out the application in his own handwriting, and we ask various ques- 
tions. 

Q. What is the average proportion numerically of your attendants 
to the number of your inmates? 

A. Do you make a distinction between the attendants and em- 
ployes? 

Q. Take the nurses. 

A. About one to eight. 

Q. That is, their attendants day and night? 

A. That is, taking the employe®, but if you take the people who 
are in care of the patients we have one to fifteen. 

Q. That is what I want to get at. 

A. That is it, one to fifteen. 

Q. Your percentage would not necessarily be as large as where 
they have acute cases, there they have one to ten generally? 

A. No, sir; not necessary to be as large. 

Q. What are the requirements of admission, under the existing 
law, for a patient in your institution, where do you draw your 
supply from and what rules do you have governing the admission 
of them? 

A. Our capacity is eight hundred; when that number is reduced 
by death or transfer I report that matter to our board of trustees 
and they authorize me to make a request to the Committee on 
Lunacy of the Board of Public Charities for the number of patients 
to make up that number and they are selected from the various 
State institutions or county institutions and authority is given us 
to get a number of patients from certain institutions and transfer 
is made to this institution. 

Q. You don't have anything to do with the selection of the pa- 
tients that are brought here? 

A. No, sir. 

Q. You have to take those who are sent to you? 






287 

A. Yes, sir. 

Q. What is the source of water supply for drinking purposes? 

A. The source is from a stream which runs through our own 
grounds; it is practically spring water; it is a small mountain stream 
drawn off the mountains back of us. The headwaters are about 
a mile or two miles from the buildings. We have excellent water 
for our use. We have a filtering plant but it is more for the pur- 
pose of clarifying the water than for filtering as it gets muddy some- 
times in storms and the filtration is for the purpose of clarifying it. 

Q. Wliat sewage system have you here in use for your institu- 
tion? 

A. We have a sewage system; at the present time we are running 
our sewage from the buildings to a well which is about fifteen hun- 
dred feet from the buildings, and we pump it out from there over 
the farm and are using it for fertilizing the soil. We formerly 
had the Waring system and it did not work satisfactorily. As I 
have stated, the well is about fifteen hundred feet from the build- 
ing; it is eighteen feet deep and has a capacity of about sixty thou- 
sand gallons. We pump all day and half the night. 

Q. How are your buildings heated? 

A. Heated by indirect steam. 

Q. And the ventilation, I presume, is the most modern? 

A. We have a modern system of ventilation; we have the fans 
in the basement by which we force the fresh air up and have two 
motors for suction. 

Q. Is there any systematic method of inquiring into the state 
of health of your patients at any stated time? 

A. Yes, sir; we have visits daily by the physicians. 

Q. You have your own physicians here all the time and they are 
constantly at the call of the attendants? 

A. Yes, sir. 

Q. And they make daily visits through the wards? 

A. Yes, sir; and every part of the house, and make sanitary in- 
spection of the house also. 

Q. Are there any women on the board of managers of your in- 
stitution? 

A. No, sir. 

Q. Do you believe that, if the practice was adopted as is the case 
at the Utica Hospital, in the state of New York, and other hos- 
pitals in the state of New York, it would be a benefit? 

A. I could not see any benefit in placing women on the board of 
managers. 

Q. How many visits do the board of managers make to your insti- 
tution? 



288 

A. That would be pretty hard to say; some of them are here every 
week. We have a regular monthly meeting. 

Dr. Lemberger. Our record book will show that the visiting com- 
mittee is called on every month to make a report and invariably 
they come to report. Col. Zimmerman happens to be on this com- 
mittee and among us there are several meetings between the monthly 
meetings. I took occasion this morning to drive around and look 
at some of the work. 

Q. Some of the board of managers make several visits a month? 

A. Yes, sir; every two weeks and sometimes every week. 

Dr. Lemberger. We drop in unawares to those in charge here. 

Q. And once a month you come together regularly? 

A. (Dr. Hill.) Yes, sir. 

Q. Have you women nurses and attendants? 

A. Yes, sir. 

Q. Do they bear about the same proportion, numerically, to the 
male nurses? 

A. Yes, sir; we Lave two hundred women patients and six hun- 
dred men patients, but the proportion of attendants to patients is 
about the same on each side of the house. 

Q. In the women department you have women nurses exclusively? 

A. Yes, sir. 

Q. Have you women physicians? 

A. Yes, sir. 

Q. In the women department? 

A. Yes, sir. 

Q. What w r ould you think of the system of furnishing supplies for 
institutions of this kind if they were furnished from some central 
place, the same as the prisons of the State and as New York has 
in use in its institutions, would it be a saving to the taxpayers 
and at the same time would you get as good supplies as under the 
present system? 

A. I am inclined to believe, of course I know nothing about the 
other system, only ours, but I am inclined to believe that our® is 
the better one. 

Q. You are able to obtain produce here cheaper than if it was 
supplied by a State board? 

A. Yes, sir. 

Q. Their experience in New York state has been that the material 
can be supplied cheaper locally than it can be through a central 
board? 

Mr. Shenk (a trustee). Doing the way the people do here I don't 
see how they can get it cheaper, and if it is not proper it is sent 
back. 



289 

Dr. Hill. Every one files a bond of one thousand dollars. 

Dr. Lemberger. Take, for instance, our supply of beef. We fur- 
nish our own beef and slaughter cattle as we need them. We be- 
lieve from our making tests that we get a better quality of beef; 
we cannot always do it but we find it to be an advantage to the 
institution. 

Q. (Mr. Heidelbaugh.) You kill your own cattle? 

A. No. sir; not altogether, but we fatten from fifty to sixty 
cattle in a winter and believe we could fatten more if we had more 
room and to that extent we use our own. 

Q. You kill all you fatten? 

A. Yes, sir; and we let some of our cows get fat and kill them. 

Q. (Mr. Snyder.) What is your contract price for beef now? 

A. We made a contract on July 1st and that amounted to $9.47; 
the bid was $9.47. 

Q. A year ago how was it? 

A. It was $7.50, or something like that. 

Q. One institution, I think, made a contract for $9 and one for 
$10 for this year. Is it Chicago beef? 

A. Yes, sir; we make our contracts every three months. 

Q. Do you have any system of examination of the beef, I mean a 
microscopical examination, before it is used? 

A. We have not done that, but we do examine it closely. We have 
a regular butcher employed and he is a very good man and he looks 
to it. 

Q. Have you a pathologist in the institution? 

A. Yes, sir; and he attends to this work. Heretofore we have not 
done so because the beef has been good. 

Q. I do not know whether that theory, that tuberculosis cannot 
be communicated from milk, will hold good, for I see it is disputed? 

A. Yes, sir; I see it is disputed. 

Q. How are your buildings lighted, by electricity? 

A. Yes, sir. 

Q. How many hours are your attendants on duty? 

A. They go on duty at 5 o'clock in the morning, that is, every- 
body gets up at 5 o'clock in the morning, patients and attend- 
ants, and we let a certain number off at an earlier hour but 
at half past eight at night the lights are out and everybody is off 
duty and the night nurses are on duty from 8 o'clock until 5 o'clock 
in the morning. 

Q. Have you separate buildings for the nurses to sleep in? 

A. No, sir; they sleep in the halls between the dormitories. Each 
attendant has a single room limited to themselves, which opens 
into a hall and this hall connects the dormitories. 

19 



290 

Q. Is there entire freedom from noises? 

A. They could be disturbed if there was any noise made in the 
dormitories. 

Q. Of course you don't have that noisy, unruly class of patients 
in this institution? 

A. No, sir. 

Q. Most people think it is an advantage to have a separate build- 
ing away from the institution where the nurses can go to rest? 

A. Yes, where they have the violent insane I think it is the best 
plan. 

Q. You have six hundred male patients and two hundred female 
patients, at this time, in this institution? 

A. Yes, sir. 

Q. How does it come that the number of male patients is so 
much greater than the female, is it because of the greater proportion 
of such people come from among the men than the women? 

A. No, sir; but because employment could be found more for the 
women than the men. 

Q. What percentage of male patients work in connection with 
this institution? 

A. We are sending out 450 of the 600 to work. 

Q. And what proportion of the females? 

A. Well, about 150 to 175 of the women are doing some work. 
Of course some of the women, when we say they work, that means 
they sit down and sew on buttons; we count it as work but it is 
not a great deal of work. 

Q. At Wards Island they told us that 80 per cent, of the women 
worked there but some of them just picked hair. 

A. We do that too; we get everybody busy if it is only to some 
little thing like that and sometimes we give them that employment. 

Q. And the men, I think, they only get about 50 per cent, to do 
anything? 

A. We get more than that. 

Q. That is the almshouse of New York and they have everything 
there, the acute and all classes of cases. 

'Mr. Shenk. When these counties put up an institution they will 
have all that mixture in their institution? 

Mr. Snyder. Yes, sir; they would have to keep all classes in them, 
Tery likely. 

Mr. Shenk. I don't see how they can do it. 

Mr. Snyder. They claim, in Chester county, they do it. 

Mr. Shenk. They get one dollar from the State? 

Mr. Snyder. They get $1.50, the same as the other institutions. 



291 

Q. Mr. Heidelbaugh.) When you make your requisition for patients 
do you ask for the number? 

A. Yes, sir; if we have room for four men and six women we 
say to the Board of Public Charities, we would say when we would 
like to have four men and six women, and authority for the transfer 
is given. 

Q. So that keeps your proportion the same all the time? 

A. Yes, sir. 

Q. (Mr. Snyder.) How often does the Board of Public Charities 
visit your institution? 

A. Officially twice every year, two members of the Board. 

Q. Do they go through all parts of the hospital? 

A. Yes, sir. 

Q. Mr. Biddle, I suppose, is one of them? 

A. Mr. Biddle is always one of the party. 

Q. Do you place restrictions upon communication by letter from 
your patients? 

A. Yes, sir; to a certain extent. We allow our patients to send, 
at least, one letter out a week. 

Q. And you look over the letter? 

A. Very seldom, unless a patient will simply write a letter that 
cannot be deciphered and we don't send that out; we allow some 
patients to write more than one letter, those are sensible. 

Q. You place no restrictions on patients who want to send letters 
to the county judge or district attorney, which is provided for by 
law? 

A. No, sir; they have a right to do that and to the Board of Public 
Charities. 

Q. Is it the duty of the Lunacy Commission and the Board of 
Public Charities to get here more than once a year? 

A. The agent of the Committee on Lunacy comes oftener than 
that, that is Dr. Wetherill. He does not come at any regular stated 
time but he drops in any time. 

Q. Are there patients who get in your institution, about whom 
you have doubt as to their insanity? 

A. We never had a case here which was not insane. 
Q. Have you any suggestions or recommendation to make in 
regard to the laws governing the admission of inmates; can you 
make any suggestions with reference to the present law with re- 
gard to the admission of patients to this institution? 
A. No, sir; I can't make any. 

Q. Have you noticed any abuses which have occurred under the 
existing system of admission? 

A. Yes, I must say I have in years gone by. We cannot make 
the complaint at the present time, but formerly the other institu- 



292 

tions sent patients here who never should have been sent here. 
They sent infirm patients, crippled patients, sick patients, seventy- 
five years old patients, who needed hospital attention, who needed 
to be attended to, as well as children and violent patients. The bill 
called only for able bodied, quiet patients. 

Mr. Shenk. Dr. Wetherill claimed that they did not send pa- 
tients that he had selected to be sent here. They would bring in 
patients and Dr. Wetherill would examine them and order them 
to be sent here, and there being a great deal of prejudice against 
this institution at that time, they would take those patients back 
and send others who should not have come here and Dr. Wetherell 
discovered that, but in the last three or four years they have not 
done that. Dr. Wetherill stated plainly that they had substituted 
other people for the ones he had selected and that they were not 
the people he examined and wanted sent. They wanted to make it 
appear that by sending them here they got so much worse and then 
they had to be sent back which was on account of the feeling, more 
or less, that existed three or four years ago, but I don't think there 
is so much now. 

Q. Is the line of demarcation tightly drawn between the male and 
female inmates as to social life? 

A. Yes, sir; we are very careful about that. We never had any 
difficulty in that regard. 

Q. What formula is adopted to obtain the discharge of a patient 
from liere? 

A. When we have a patient who has recovered sufficiently, as 
we think, to go home, an application is made by the friends — I make 
a report monthly on the physical condition to the Board of Public 
Charities and they act on that report and they give their consent 
to his or her discharge. I cannot discharge a patient without their 
consent. 

Q. Would it not be expedient for some uniform system of book- 
keeping to be adopted, or that each institution has its own system? 

A. We think ours is the best. I wish you would look over our 
books; the trustees have not had any fault to find with the system 
in use by us. I would say that, perhaps, some common system 
would be a good thing. 

Q. It would expedite matters, no doubt, so far as the accounting 
officer in the State is concerned? 

A. Yes, sir; but I don't think we have any trouble of that kind. 
We get along very well with the auditor. 

Q. Might not a conference of superintendents prescribe a system 
of uniform blanks administering the affairs of all the hospitals in 
the State? 



293 

A. I should think a conference of that kind would be a benefit 
to all the superintendents and a benefit to the institutions. 

Q. What provision has been made in the case of the outbreaks 
of any contagious disease? 

Q. We have a separate building; we never have been granted a 
special appropriation for a hospital building but we have restricted 
a farm house and we have a place there for isolating any contagious 
diseases. 

Q. Have you had any recently? 

A. Not recently; we have had at various times. We had one 
case of scarlet fever several years ago. Three or four years ago we 
had a number of cases of dysentery. We never had a case of dipn- 
theria or small-pox. We keep a case of anti-toxine here and needles 
all the time in case there should be anything break out. 

Q. At the Williard Hospital, in the state of New York, we found 
that they had a number of cases of diphtheria and that they are 
having a great deal of trouble in getting rid of it. They use anti- 
toxine there. They have used every means possible in order to get 
rid of it and have gone so far as taking the paper off the walls 
and painting the walls and in some cases they have taken the 
flooring up in some of the rooms. 

A. I should be afraid of their never getting rid of that trouble 
at Williards. When it has occurred so many years in succession, 
it would seem, that they have not succeeded in finding the location 
of the germ. 

Q. Are patients transferred from this institution to other insti- 
tutions sometimes? 

A. Yes, sir. 

Q. What is the formula for that? 

A. We have to have the consent of the State Board of Charities. 

Q. You do just the same as you do for the admission of inmates, 
just the reverse? 

A. Yes, sir; we must get the written authority. 

Q. Do you think the application of correct civil service principles 
for the employment in the various hospitals would be beneficial; 
in this State you could use them so far as the nurses and attendants 
were concerned? 

A. Yes, sir; I think it should be but I should think if we apply 
civil service rules we ought tc be allowed to pay higher wages. We 
would have to pay higher wages; we could Dot get the class of people 
unless we would pay higher wages. 

Q. What is the average payment here? 

A. The men attendants begin at $18 a month and after six months 
satisfactory service, we don't adhere to this strictly but we say 
to a man when he comes here, we start you at |18 a month, and if 



294 

you give satisfaction at the end of six months it will be $20 and 
after one year §22 and after two years $24, but in the meantime 
we may possibly promote him to §25. 

Q. What do you pay the women attendants? 

A. The women begin at f 12 and advance to $16. In some special 
cases we have an attendant who takes a number of men and goes 
out and looks after the cows, he gets paid special wages. We have 
another man who takes a little group of men patients and looks 
after the chickens and pigs, and so on through the different depart- 
ments. Those men are attendants and are responsible for the 
welfare of those they have in charge. 

Q. Do you think that female attendants should be paid the same 
as male? 

A. Xo, sir; I don't think they should. We can get a very good 
class of women attendants, bright girls, around through these coun- 
ties surrounding us. 

Q. You always have plenty of applications? 

A. We always have a waiting list. 

Q. Have you any system of religious observance in your institu- 
tion? 

A. We have non-denominational services conducted every Sunday 
morning, which consists mostly of singing. We have both Protest- 
ant and Catholic ministers come in. 

Q. Do you have any system of instruction connected with the 
institution? 

A. We keep up a school of instruction for the nurses in which 
I give instruction. We have a consulting staff and they come here 
occasionally. In cases of surgery we call in the consulting surgeon. 
We have an operating room. We have no prescribed course. We 
are constantly giving patients instruction in the industrial depart- 
ment. 

Q. How young are the youngest patients you have here? 

A. Twenty to twenty-three. The large majority are adults. 

Q. Have you ever given the subject for the prevention of insanity 
much thought? 

A. I do give it some thought, although of course my work here 
is sufficient to keep me busy taking care of the family I have. I 
have given it some study but I do not have much time for anything 
else than my duties in connection with the patients. 

Q. You have no suggestions to make as to anything that would 
prevent it? 

A. I have thought if we could adopt the Xew York system to 
good effect, having an institution for the temporary detention of 
patients and having them examined and taken care of there for a 
time before being sent to the State institutions for care, that it 



295 

might be a good thing. It is a temporary detention in order to 
determine whether the patient should be sent to the State hospital ; 
it is about thirty days, I think. 

Q. Then they are either assigned to a ward, or if they have im- 
proved sufficiently they are put into a very mild ward, or if they are 
more violent they are put into a ward that suits that kind of pa- 
tients? 

A. Yes, sir. 

Q. Who has charge of the discharge and employment of attend- 
ants here? 

A. Under the authority of the board of trustees the superintend- 
ent has charge of that. 

Q. What would you think of a frequent conference of the superin- 
tendents and physicians of the different institutions of the State 
if they would come together every month or two months? 

A. I think it would be an excellent thing if we could have an 
interchange of ideas in that way. 

Q. You do not now meet at all in conference? 

A. No, sir; except incidentally. If I have time I sometimes go 
to another institution. I have visited the other institutions at 
various times. 

Q. But regularly you do not meet the superintendents of the 
other institutions? 

A. No, sir. 

Q. The law with reference to the transfer of female patients is 
strictly adhered to so far as female attendants are concerned? 

A. Yes, sir; there is always a woman attendant sent along. 

Q. I think you answered with reference to fire escapes in a sepa- 
rate report? 

A. Yes, sir; I might say that we have very good fire protection. 

Q. Your buildings are the last State buildings of this kind built 
in the State? 

A. Yes, sir; we have only two story buildings, and as I stated we 
have slate and metal staircases, which are a protection against 
fire. 

Q. As one of the trustees stated there has been a good deal of 
feeling against the hospital for the care of the chronic insane, not 
believing it to be a proper thing. I have a letter here, I will not 
mention who wrote it, but I will ask you to answer the questions 
after I read it. The letter is as follows: "My experience, supported 
by that of the best men at home and abroad, assures me that the 
plan of separate hospital treatment for the curable and incurable 
insane is a mistake. 

"Whatever deprives one, sane or insane, of hope can redound to 



296 

nothing short of calamity to that individual. 'Who enter here 
leave hope behind.' is a sorry inscription for the lintel of any 
habitation. The hope of recovery is the cherished thought of 
many of the chronic insane. I recall the parting words of a patient 
who was transferred from this hospital to Wernersville, 'Good bye, 
doctor, I shall not see you again. They don't get well where I am 
going.' 

"A hospital for the chronic insane would make, in many instances, 
a life long separation of husbands and wives, parents and children 
— the poor man of remote counties can ill afford to visit his insane 
relations, the distance is too great and the expense often beyond 
his reach. 

"Isolated from recent cases, there is danger of reducing the chronic 
insane to pauper diet, restrictions and privations. 

"The chronic insane are really a help to the acute — with rare 
exceptions they work willingly together. I have seen many acts 
of kindness shown by the veteran sufferer to his unfortunate neigh- 
bor which paled the best efforts of the attendant, who prided him- 
self upon his efficiency. 

"The labor of the chronic insane is profitable to the hospital for 
recent cases and is more remunerative than it could be were large 
expenditures made for land, buildings and other indispensables to 
provide for their separate care. 

"Let us give our incurable insane the advantage of the medical 
care and humane consideration, which we would ask for our own 
loved ones; then, and not until then, we will have discharged our 
duty to them." 

Now we will take this up separately. In reference to the condi- 
tion that exists when they come here, that there is no hope for them 
becoming cured. What has been your experience? 

A. That idea is not given to them; we encourage them to hope 
they will get well in every case. 

Q. Do they form that idea themselves, that whenever they are 
sent here, "My case is incurable, there is no hope for me?'' 

A. No, sir; they do not. This one case may be true; I don't say 
that that did not occur. 

Q. Is it not the impression, at least, that the cases sent here are 
incurable cases? 

A. That is the impression with many people and it is true, too, 
many of them really are incurable cases as the men who sent them 
here say they are. They say. by sending them here, that they are 
but we do not tell any patient, either he or she. that they will not 
get well. We give them hope that they will get well. 

Q. You do not tell that to patients, that when they come here 
it is all up with them so far as being cured is concerned? 



297 

A. I think if that impression ever arose it was given to them at 
other institutions. 

Q. Do you find them coming here with that impression? 

A. No, sir; I say I don't believe so. There are only one or two 
cases among the patients who have said something like that. 

Q. You don't find all your patients coming here with that idea? 

A. No, sir; not by any means. Only one or two cases, many of 
them would think enough, but I ask you to ask the patients your- 
selves and I assure you that we disabuse their minds, those who 
have that idea and there are very few with that idea. 

Q. You hold out to them that their's is a mild case and there is 
hope? 

A. We say they come here for treatment and we will do the best 
we can for them. We encourage them and do the utmost we can for 
them. You will find that our people hope right on, hoping to the 
end, and we encourage them, although it does not seem right to 
deceive their friends by saying to some person that his brother or 
husband will get well. We tell the friends the truth, but we en- 
courage the patient to hope. 

Q. A hospital for the chronic insane would make, in many in* 
stances, a life long separation of husbands and wives, parents and 
children — the poor man of remote counties can ill afford to visit 
his insane relations, the distance is too great and the expense often 
beyond his reach? 

A. That is one objection we have. People from the far western 
counties, and as the statement is made here, the expense is some- 
times too great for the friends to make a visit, but that condition 
you find in any State institution, you find that same trouble and 
you find it in this institution because this is the only one of its kind 
in the State and therefore we have patients from the far western 
counties, from Washington county. 

Q. Every county in the State? 

A. Yes, eir; I think every county in the State is represented. 

Q. "Isolated from recent cases, there is danger of reducing the 
chronic insane to pauper diet, restrictions and privations." What 
do you say about that? 

A. That is a wrong statement. I ask the committee, or anybody 
who comes here to pass judgment upon the fact whether we do 
not give our people a better diet than they do at any other institu- 
tion. 

Q. I don't think that specially applies to this institution but it 
says here, there is danger of that condition sometime occurring. 
That has never been charged against your institution? 

A. No, sir; I don't think it can be justly. 



298 

Q. There never has been any charge against your institution for 
any violation of the law, relative to this institution, for the pur- 
pose for which it was founded, it is only whether it is the best 
system; in other words, whether there should be an institution for 
the chronic insane. "The chronic insane are really a help to acute — 
with rare exceptions they work willingly together." What have 
you to say about that? 

A. They may be of some assistance but the chronic insane are 
happier away from the acute insane. 

Q. Do they help to take care of the acute insane? 

A. Yes, sir; we have them wait on the sick in the hospital and 
work keeping the rooms clean. 

Q. "The labor of the chronic insane is profitable to the hospital 
for recent cases and is more remunerative than it could be were 
large expenditures made for land, buildings and other indispensa- 
bles to provide for their separate care." The class of patients in 
the institution here are able to perform more work? 

A. Yes, sir; and can do it better here than in other institutions 
because we employ them more systematically. 

Q. What do you say are the advantages of having a hospital for 
the chronic insane? 

A. In the first place I think it is an advantage to separate them 
from the acute insane. As to employment we get better results 
because we have more systematic employment and there is no doubt 
in my mind that we are caring for our people at a lower rate per 
capita than any other institution because we can do it on account 
of having this class alone. 

Q. What do you think of dividing the State into districts; we 
all realize that there are not enough hospitals to care for the insane, 
suppose that the State was divided into hospital districts, com- 
posed of several counties where they are small, as in the case of 
judicial districts, say there are ten in the State, I don't know that 
that would be the number required but take that as a hypothetical 
question, do you think it would be an advantage? 

A. Yes, I think that would be a good idea. 

Q. Then that institution to have a separate department for the 
different classes of insane patients, or would you approve of having 
a hospital separate for the criminal insane, just one hospital? 

A. I think there should be a separate institution for the criminal 
insane and a separate institution for the epileptics. The epileptics 
are a class by themselves and the most unfortunate class and diffi- 
cult to care for and are the most dangerous persons. 

Q. Like animals? 

A. Yes, sir; in many respects. 



299 

Q. Suppose money was no consideration, which, of course, it 
is not in Pennsylvania, suppose money was no consideration in the 
care and treatment of the insane, what would you say would be a 
model way of taking care of those unfortunate people in this State, 
as to the number in a hospital, I am speaking of all classes, not 
only the chronic insane but the acute as well — in general, do you 
think an institution having two thousand is advantageous over 
one having one thousand? 

A. I should say a thousand people would be enough to keep in 
one institution. A larger number than that makes a very unwieldy 
family to manage. 

Q. Would you have, connected with that institution, a separate 
ward for epileptics, or a separate institution? 

A. A separate institution under separate management. 

Q. Would you have a hospital for the criminal insane as a sepa- 
rate institution? 

A. Yes, sir; and separate management. 

Q. Would you have it under the control of the prison authorities 
and part of the prison? 

A. No, sir. 

Q. Would you have that also separate? 

A. Yes, sir; because if you did not you would apply some of the 
prison rules to the criminal insane and we all know that we must 
treat them differently. You cannot treat them the same as you 
do criminals. You have to be more strict with them. They have 
such an institution at Matteawan, in the state of New York, and your 
commission should visit that institution, as well as the one at 
Gallipolis, in Ohio, which is a place for the care and maintenance 
of epileptics. Speaking further of the criminal insane, you must 
not lose sight of the fact that you are dealing with desperate 
people; they are insane, no doubt, but they are desperate and they 
will attempt violence if not watched in such a way as to prevent it. 

Q. Would you establish more institutions for the chronic insane 
in the State of Pennsylvania than the one, or do you think it is 
sufficient; in other words, would you relieve some of our present 
hospitals of this class of cases by establishing another institution? 

A. Yes, sir; I should be in favor of establishing another insti- 
tution for the chronic insane for I think it has been a benefit to 
the other State hospitals. It has relieved them from being crowded 
and taken away the chronic cases and allowed them more time and a 
better chance to treat their acute cases. 

Q. And you would have separate institutions for the feeble- 
minded? 

A. Yes, sir. 



300 



Q. I think the number of feeble-minded persons and epileptics 
is about ten thousand in the State and that only two thousand are 
in institutions and eight thousand are at large in families. Those 
people, many of them, are producing children? 

A. That is a very unfortunate state. 

Q. What do you think of the law of castration? 

A. I should be in favor of it; of course it is an extreme measure, 
a radical measure. I should be in favor of castrating habitual crim- 
inals. It is a radical measure, taking away their power to bring 
forth their kind, but that appears to be the one radical way to get 
rid of it. But you would have to bring public sentiment around to 
it first and then get a legislative enactment. 

Q. (By Mr. Anderson.) There was a law passed last winter pro- 
hibiting first cousins from marrying; what do you think of that? 

A. I think our marriage laws cannot be too strict; I think that 
was a good measure. 

Dr. Lemberger. I think the general impression is that marriage 
among blood relatives produces imbecility. 






LEGISLATIVE COMMISSION TO INQUIRE INTO THE CONDI 
TION OF PENNSYLVANIA INSANE. 



Inspection of the County Hospital for the in- 
sane of the Central Poor District at Retreat, 
Luzerne County, Pa. 



AUGUST 9th, 1902. 



(301) 




(303) 



INSPECTION OF THE COUNTY HOSPITAL FOR THE INSANE 
OF THE CENTRAL POOR DISTRICT AT RETREAT, LUZERNE 
COUNTY. PENNSYLVANIA, AUGUST 9, 1902. 



The Hospital for the Insane and the Almshouse of the Central 
Poor District of Luzerne County, Pennsylvania, is located at Retreat, 
in Newport township, on the line of the Sunbury and Hazleton Rail- 
road, a branch of the Pennsylvania Railroad system, about eleven 
miles from the city of Wilkes-Barre. 

The buildings are located on a high hill overlooking the North 
Branch of the Susquehanna river. A small station has been erected 
by the railroad company. The lands belonging to the asylum and 
almshouse comprise about 140 acres, most of it being farmed for 
the use of the inmates of the two institutions. The buildings for 
the insane and those for the poor are located some distance from 
each other and the accounts of each are kept separately; they are 
almost as distinct as if only one or the other existed on the grounds. 
In fact the first almshouse building was erected in 1878, and it was 
not until twenty years later that steps were taken to erect buildings 
for the accommodation of the indigent insane. 

The Commission arrived at this hospital on Saturday, August 9, 
1902, and were met at the station by Dr. Charles B. Mayberry, super 
intendent, and his assistant, Dr. A. C. Voigt, in company with Mr. 
D. A. Mackin, steward of the almshouse. These officials were after- 
wards joined by the board of directors and together a tour of in- 
spection was made. 

The Commission was shown the drug store and offices and rooms 
in the main building and was then conducted to the women's build- 
ing and inspected the halls, wards and dormitories. It was ex- 
plained that the bedsteads were made of the best steel and iron, the 
posts setting on rubber; that the springs were double and guaran- 
teed for ten years; that the mattresses were made of. South Ameri- 
can horse hair, weighing 23 pounds; that the bed was of the very 
best make. The Commission passed through the day room, lava- 
tories, dining room and other rooms. The operating and lecture 
room for nurses was also shown as well as the sewing room. The 
women make everything except the men's outside clothing. All 
the underclothing and over-alls are made up by the inmates, a 
sample of them being shown to the Commission. 

(303) 



304 

The fire escapes were examined and their utility explained to the 
Commission. The chapel was also visited, it having a seating ca- 
pacity of about six hundred. Here is also an amusement hall, hav- 
ing three sets of scenery connected with the stage. 

The Commission was also shown through the male wards. These 
are entirely separated from the female wards by the main building. 
The male dormitories, dining room and other rooms and conveni- 
ences were duplicates of those in the women's building. It was 
noted that as large a day room was used for the convenience of the 
patients as exists at any of the larger State institutions. About 
15 per cent, of the men were unable to work by reason of their 
physical condition. Many of the inmates had been transferred from 
other institutions, they being in part the aggregation of years in 
other institutions. 

One of the hose passages was exhibited to the Commission in the 
basement floor. It was connected with every floor and there was 
a direct connection with the standpipe, in which the water has a 
pressure of between eighty and ninety pounds; thus all parts of 
the various buildings could be reached by means of the system in 
practice. 

The bakery was visited. Sixteen barrels of flour are used per 
week; one practical baker is employed and he is assisted by the 
patients in the making of bread for the use of the insane department 
as well as of the almshouse. The ventilation system was explained 
by Dr. Mayberry. In the system used the air is heated and forced 
in from below. By means of two powerful fans ventilation is fur- 
nished to all parts of the different buildings and every room is 
supplied with pure fresh air. The entire structure is heated and 
ventilated by forced draughts. 

The distributing store and stock room were also visited. An ice 
box was shown in the kitchen. It is cooled by means of brine and 
no ice is used in the kitchen. A charcoal broiler was also pointed 
out and it was stated that meat could be broiled at one time for 
five hundred persons. The laundry was visited, it being located 
over the kitchen and there being a large air space between the two; 
modern dryers were in use. The power house plant, the cold storage 
building an ice plant were also visited. It was stated that there 
were in cold storage, or about to be placed therein, 225 tubs of 
butter, 140 crates of eggs and 22,000 pounds of beef. The butter 
is furnished by the Elgin Creamery Company. A ton and a half of 
ice could be manufactured by the ice machine every twenty-four 
hours. During the inspection of these important adjuncts to the 
successful running of such an institution it was stated that the 
egg room was ten above zero and the butter room at zero. The 
refrigerating room was lined with cork from two to two and a half 



305 

inches thick. This was the first institution, either State or County, 
in which the Commission was able to find an ice plant in use, 
although within sight and but a short distance of the North Branch 
of the Susquehanna river. 

The work of excavating, filling, grading, &c, of the grounds by 
the labor of the patients and the sewerage, the laying of pipes and 
similar services are performed by them. A vast amount of labor 
appears to have been required to have brought the buildings and 
grounds to their present state of completion. 

The Commission witnessed a game of base ball played by patients 
and attendants and from observation very little difference was no- 
ticeable between it and a game played by those who were entirely 
sane. There was an absence of the wrangling and disputes that 
very often arises in games of ball among sane people. 

After the examination of the premises was completed the Com- 
mission, together with the officials and directors, met in the recep- 
tion room, when the following took place: 

Dr. Charles B. Mayberry called and testified as follows: 
Examination conducted by Mr. Snyder, chairman. 
Q. Do you find this county system to be an advantage in the care 
and treatment of the insane? 

A. It is operating very nicely with us. 

Q. When did you first move into this institution for the care and 
treatment of the insane? 

A. We received the first patient on June 1, 1900. 
Q. Do you take patients from all over Luzerne county? 
A. Yes, and Carbon; we have a population from which to draw 
patients close to three hundred thousand, that we take care of and 
treat the insane. 

Q. What is your present number of patients in this institution? 
A. Four hundred and eleven. 
Q. What is the proportion of males to females? 
A. Little over fifty more males than females; that proportion 
runs right along about that ratio in all the institutions. The rule 
also holds at Danville and Norristown. 

Q. Have you any patients in other institutions from this county? 
A. The county has quite a number of districts that send to Dan- 
ville; for instance, Pittston sends to Danville, this being a special 
district. 

Q. You have a special line dividing it off from other portions of 
the county of Luzerne? 

A. There is a district known as the Middle Coal Field district, 
which includes the southern portion of Luzerne and part of Carbon, 
which is not in our district. We ore known as the Central Poor 

20 



306 

District and it includes the city of Wilkes-Barre and also includes 
six or seven townships and about a dozen boroughs. Then as to 
the care of the cases in the State Hospitals, I would say, that when 
we transferred the cases from other districts to this district we left 
about a half a dozen patients who were physically unable to come 
here and they are still at Danville; with that exception we have them 
all here. 

Q. Are they violent cases? 

A. No, sir; it is on account of their physical condition and ina- 
bility to be removed. We have no violent cases. 

Q. Are you as well able to take care of violent cases here as at 
other hospitals? 

A. Yes, sir; just as able in every respect. We have something 
like twenty inmates committed by the courts either after trial for 
criminal offences and acquitted on the ground of insanity, or pro- 
nounced insane by a commission after hearing testimony. 

Q. Then you have the criminal insane here? 

A. Yes, sir; we take everything that comes. However, we have 
a special predilection for curable cases. 

Q. I noticed an article in a newspaper to-day in which Dr. Chapin 
recommends separate confinement? 

A. Yes, sir; that is what has been practically advocated by me 
for the last ten years. What we want to do is to cure more and I 
am heartily in favor of such a movement. I wrote an article on 
that very subject some ten years ago and it was published in the 
various medical journals but it did not meet with favor at that time 
and was pronounced by some to be in advance of the times. I think, 
above all, we should have a separate place for the curables and in 
that way bring about more cures. 

Q. Your idea would not be to have separate hospitals but in every 
hospital have a separate place for all curable cases? 

A. That is one way; but the ideal way is to separate them from 
the hygienic environments of the large asylums of chronic cases 
and have them alone in separate buildings, the acute, the epileptic 
and the criminal insane, and establish a "psychopathic hospital" 
because it would be more favorable to cures. It is not a good 
thing to have fastened on the individual the stigma of being in an 
insane asylum when he goes out and on that account there is a 
great opposition to being placed in an insane asylum and the cases 
who are cured dislike very much to have attached to them the fact 
that they have been in insane asylums. A great drawback to those 
who are cured is for them to be told by their friends and others that 
they have been in an insane asylum; therefore I think the estab- 
lishment of a small place for the curable cases, such as a psycho- 



307 

pathic hospital (which has not the asylum associations) would bring 
about the greatest number of cures and render them more liable to 
be permanent. 

Q. Suppose money was not taken into consideration for the care 
and treatment of the insane how would you arrange this State for 
the best care and treatment of the insane? 

A. In the first place I would make every institution that could 
contain five hundred cases a State asylum. In the second place I 
would arrange practically near the large cities, or as near as pos- 
sible, about a half a dozen "psychopathic hospitals" with accom- 
modations for not over sixty patients and they would never enter 
an asylum or a larger place for the insane until pronounced incura- 
ble. I would have one each in every center of a large population; 
six would be sufficient for the whole State. The plan would not 
be very expensive. 

Q. By this plan the patients would not have the stigma placed 
upon them of having been in an insane asylum? 

A. No, sir; because it is not favorable to cure to have them mingle 
with each other, nor is it a good thing to have this stigma placed 
upon them. In such a place as a "psychopathic hospital" they 
would not be considered to have been in an insane asylum. In fact 
I have had cases come back to us due to nothing else but the fact that 
they had been in insane asylums previously. New York has always 
taken the stand that it is a good thing to build an acute ward on 
the same grounds but separate from the chronic; New York has been 
trying to do that for some time. Go to Buffalo and in the asylum 
there you will find two wards for the treatment of the acute, and 
the only objection is the association of the fifteen hundred others. 
Each of the large institutions should have constructed a small ward 
for curable cases wholly detached from the other wards. You saw 
how it was at Willard for the acute curable cases; that is practically 
what Pennsylvania might do to-day. 

Q. What size hospitals would you erect, suppose we were going 
to take care of all the insane, suppose we would make an effort to 
take care of all of them, what size hospital would you suggest, 
taking into consideration all classes? 

A. I could not see any objection to anywhere from one thousand to 
fifteen hundred if you are going to include the chronic cases; if 
the acute cases I would not say over six hundred. 

Q. Suppose ten or twelve districts were established and yon erect 
enough hospitals, take those already erected and erect enough to 
care for them properly, would you think of placing more than one 
thousand patients in them, and that that number would be sufficient 
to cover the whole State? 



308 

A. Eight hundred ought to cover the whole thing. 

Q. Suppose there were established ten districts in the State and 
a hospital built in each of the districts with a capacity of one thou- 
sand, do you think that would be sufficient? 

A. Yes, sir; I think a thousand would cover it. There are some 
old dements in almshouses that are hardly counted. 

Q. How would you arrange for the chronic insane, would you 
have them placed in a separate hospital? 

A. Yes, sir; but I would remove the acute from the chronic and 
not the chronic from the acute. 

Q. You think this was putting the horse behind the cart? 

A. Yes, sir; we did not move the cart but we moved the horse 
and the relief that was sought to be afforded to other hospitals was 
no relief at all. 

Q. Would you have separate hospitals for the criminal insane? 

A. Yes, sir; I think there should be, without getting into too 
much classification. I think a hospital like Matteawan would be de- 
cidedly a good thing. 

Q. Suppose you had but one hospital for the criminal insane in 
the State, do you think that would be sufficient? 

A. Yes, sir. 

Q. And what do you have to say about the epileptic? 

A. You could take about fifty or sixty per cent, of the epileptic 
out of the asylums and the rest you could not. The epileptic run 
about one to ten through the State but you could probably take 
sixty per cent, out and there would be thirty-five to forty per cent. 
at times that it would not be advisable to take out of the present 
asylums and place them in epileptic asylums for the reason that 
they are epileptic insane and that class you could not keep there. 

Q. Suppose you were going to revise the laws of this State with 
respect to insane asylums and you would not take into consideration 
the cost, but the best care and treatment of these people, give us 
your idea how this State ought to be arranged in this respect? 

A. 'My idea is, if it is to be done without the consideration of 
cost at all — 

Q. It is not the cost which is a primary object in Pennsylvania, 
but we want to get laws that will approach giving them, as near as 
the revenues of the State will allow, the best care and the best 
treatment for their condition? 

A. My idea would be to take all the larger asylums and make 
them chronic asylums; second, erect psychopathic hospitals as sug 
gested by Dr. Peterson of ~New York, not to contain more than sixty; 
in the third place, one only in the State constructed something like 
the Craig colony in New York, conducted and operated with a 



309 

sole view to utilize it so far as can be for epileptics; in the fourth 
place, separate insane hospitals for the convict insane separate from 
the insane and separate from the acute and chronic. 

Q. What do you think of the system of having a central board, 
such as they have in New York state? 

A. 1 don't think very much of it. 

Q. It does away with the Board of Lunacy and the Board of Chari- 
ties and practically assumes all their duties? 

A. Yes, sir; but with the centralization of power it may result 
in the breaking down of the good character of good men now and 
then. When you see a man like Dr. Wise disgraced and set aside 
it shows how possible it is for men to be tempted and led away 
from that which is their honest duty. He was one of the most 
prominent men in his line of work, so regarded among the medical 
profession, and what did Governor Roosevelt's examination bring 
out, that he was as corrupt as he could be. I think while humanity 
is built in the way it is at the present time, that where there is 
such centralization, there is almost sure to be corruption. If there 
is anything in the last quarter of a century that surprised the 
medical profession it was the result of Governor Roosevelt's investi- 
gation into the affairs of Dr. Wise. By that investigation it was 
ascertained that he used his influence for the advancement of his 
private ends. I thought, at first, that Governor Roosevelt did him 
a great wrong but Governor Reesevelt sent out a copy of his own 
report and a copy of the testimony of Dr. Wise and others which 
clearly warranted what was done. 

Q. Have you the same advantages here for the amusement of 
patients that they have in the larger hospitals? 

A. Yes, sir; I think we have everything equal to the State at 
large. 

Q. And in your institution your physicians are right here? 

A. Yes, sir; I have one assistant. The proportionate number of 
physicians here to the number of patients is about 1 to 171 and the 
proportion in the State is 1 to 172, so you see it is very near the 
same. 

Q. Are you able to separate the chronic from the acute? 

A. No, sir; not absolutely, but we can classify as much as is done 
id the State hospitals. We can meet the conditions as well as they 
can be met in the State hospitals. 

Q. Are you as well able to separate the male and female cases? 

A. Yes, sir; here is the line of demarcation (pointing to the ad- 
ministration building). 

Q. What per cent, of your patients escape and how is it accom- 
plished? 



310 

A. In no way at all, except it be from the unwatchfulness of at- 
tendants. We have very few escapes, we have only had three or 
four escapes. 

Q. Do you have an apothecary connected with the institution? 

A. Yes, sir. 

Q. Your supplies are obtained by competitive bids? 

A. Yes, sir; all except the smaller things that we buy on sight. 

Q. What percentage of your cases are cared? 

A. It is pretty hard to state that without knowing on what basis 
you wish to take it. Do you mean from the total number under 
treatment, or admissions, or what? 

Q. Suppose your average would be four hundred per year how 
many are you able to cure? 

A. Between seven to eight per cent of the total number under 
treatment and total number received., This is the first year that 
our number has not been changed by transfers to or from other 
places but probably we would run from seven to eight per cent, of 
those under treatment and admitted. 

Q. W r hat is the rate per capita, per week, for the maintenance of 
your patients? 

A. Last year it was $2.81, not counting any extraordinary ex- 
penses; we had some improvements by way of construction that 
would run us over three dollars. 

Q. Do you have a farm? 

A. There is a farm here of 140 acres and we send out patients to 
work on it but it is controlled by the almshouse. 

Q. Do they furnish market supplies to this institution? 

A. They do and we have a little concession on account of our 
patients working over what we would otherwise have to pay, but 
it is very slight. 

Q. If you had to buy everything that cost would be increased 
possibly ten cents per capita? 

A. No, sir. 

Q. It does not make that much difference? 

A. No, sir; the difference in our per capita is not the difference 
in the cost of the supplies, is not in provisions, is not in clothing. 
If you compare our averages with New York and Pennsylvania 
you will find on all the necessaries we run about the same — our 
difference is that we have not a large number of old employes grow- 
ing up among us and receiving large salaries. 

Q. How many nurses have you? 

A. We average one to ten. 

Q. About the same number as other institutions? 

A. Yes, sir. 



311 

Q. Are they trained and educated for their work? 

A. We are training them. Our first training school graduated 
this year. We are young yet. 

Q. Have you the same number of male attendants as female at- 
tendants? 

A. The same proportion. 

Q. You have about one to ten male attendants and one to ten 
female attendants? 

A. Yes, sir. 

Q. You are able to keep the noisy patients from disturbing the 
more quiet patients? 

A. To a great extent. 

Q. You have your night watchmen, or do your nurses attend to 
that? 

A. We have five on night duty, two on the women'® side and three 
on the men's side and we expect to increase it to six on account of 
several cases of homicidal tendency. 

Q. Who has access to the women's wards? 

A. Nobody but the physician and the female attendants. 

Q. You determine which of your cases are cured? 

A. Yes, sir. 

Q. And you report it in the same way as other institutions, to 
the Board on Lunacy? 

A. Yes, sir; our rules are exactly the same. 

Q. And the discharge and admission of patients are all the same 
as at other institutions? 

A. Yes, sir. 

Q. Have you small children here? 

A. Yes, sir; three boys under eleven years of age and two small 
girls. The reason the boys are here is because the Middle Coal 
Field districts could not take care of them and the Central District 
was asked to keep them. 

Q. Can you trace the cause of insanity in them? 

A. It was congenital in all and always is. Had it been possible 
I would have made a special effort in their behalf in order to have 
developed them but they are idiots. 

Q. What number of patients work? 

A. About 50 per cent, of male and female, it will average 50 per 
cent, on the whole. Since the institution has been in operation there 
has not been one dollar paid for labor other than skilled labor; 
they have done a great deal of work in beautifying the grounds and 
the laying of sewer and other pipes, grading walks and all that kind 
of work. 

Mr. Snyder. Is there any member who wishes to ask any questions? 



312 

Q. (Mr. Anderson.) Are there any separate places for the nurses 
to occupy when they are off duty? 

A. The nurses are taken out of the wards wholly, except those on 
duty. On the third floor, at the extreme end of the building, we 
have a ward that is given entirely to the women and one at the 
other end to the men and we find it to be an excellent thing. This 
comes as near as we can make it to a home without a separate 
building. 

Mr. Snyder. If there are any director® present, who desire to say 
anything, we will be glad to hear from them. 

G. H. Butler, Esq. (a Director.) There is no question in my mind 
but what our laws, relating to the criminal insane, are not com- 
plete and since we have built this institution I am impressed in 
that way more and more every day as I visit this institution. In 
fact every time I come here it strikes me there is something lacking. 
The province of the jury trial in the case of a criminal on the charge 
of a crime, the high crime of murder for instance, and the finding 
of a jury that the prisoner, there is no question about the killing, 
is pronounced insane and the commitment of that prisoner to an 
insane institution and placing him in a ward with the innocent 
insane and the co-mingling of the prisoner in that ward according 
to his class with the other insane, who have never committed crime, 
be he a public patient or a private patient, ,it seems to me, there is 
something lacking in the laws of this Commonwealth as they stand 
to-day. There is no punishment practically in it. In quite a num 
ber of instances the jury are swayed by sympathy and what not 
and the man, as I have seen them through here, I am not a physi- 
cian but am a lawyer and as I walk through the wards of this insti- 
tution I find that they enjoy the ordinary comforts of this life, and 
all that sort of thing, and they go back and forth and co-mingle 
with their fellow beings and it seems to me a pretty hard thing that 
they have to move among murderers and criminals. I do not know 
whether my sympathy carries me away from a proper feeling in 
this respect but when I walk through the wards and see an individ- 
ual who has taken the life of a fellow being and they are capable 
of enjoying all the institution affords and the commitment is to the 
asylum and whatever the asylum affords they get, it seems to me 
to be wrong that such a state of affairs should be permitted to 
exist. 

Mr. Snyder. The doctor is not only his physician but also his 
jailer? 

Mr. Butler. Yes, sir; and you cannot make fish of one and flesh 
of another. 

Mr. Snyder. Do you think there should be an institution in this 



313 

State for the care and maintenance of the criminal insane alone, 
separate and distinct from the care of other insane patients? 

Mr. Butler. I do most emphatically, whether it should be one in- 
stitution or more I am not prepared to say. There is no doubt 
about it if there is any one who thinks about it, there is no question 
about it. There should be separation and we need only cite our 
own case here because we are running as good an institution at 
this place as you will see in a good many days travel and we have a 
number of the criminal insane among our patients. 

Mr. Heidelbaugh. Do you think these individuals who have com- 
mitted murder are any more crazy than others? 

Mr. Butler. I am a lawyer and I say that when the defence of in- 
sanity is set up the very first thing they will do will be to trace 
family history and they will contend that this man was excitable 
and was queer and they will not prove auything more than what 
occurred in the last five years and in order to free him from the 
penalty of the law his counsel will do their utmost to have him 
declared insane and he is sent to these institutions to mingle among 
those who have never committed crime. 

Mr. Snyder. What do you say of a case like this: Where a man 
had got ready to murder another person, had the grave dug and 
was in the possession of an axe with which to do the killing and 
was lying in wait but some one accidentally come along before 
his wife came home. "It was his wife he intended to murder," but 
some one came along and found this man there and found that he 
was lying in wait for his wife and he was thus prevented from mur- 
dering her. "That case was cited at Warren, he had the grave dug 
in the cellar and he was sent to an insane asylum." What would 
you do with a man of that kind? 

Mr. Butler. That man has not gone through the threshing ma- 
chine of the law. Most insane people have suicidal intentions or 
other intentions and they get into a hospital of this kind and they 
are watched. 

Mr. Snyder. For the good of the community and good of the 
patients don't you think that a man of that kind is just about as 
guilty, not in law but in a moral sense, as those w 7 ho have really 
committed the act, so far as association with the other patients 
is concerned? 

Mr. Butler. Certainly he is. 

Mr. Snyder. Legally he is not as guilty and he is not because 
he has been prevented from putting his intention into execution. 

Dr. Mayberry. Of course there is a distinction between the crim- 
inal insane and the insane convict, the hardened case and the de- 
generate, and the other case of mania, is it right to class those two 



314 

in the same category, not at all. If you keep them out they will all 
become criminals. 

Mr. Butler. We have in this institution here some murderers 
who have been sent here because they have been found insane by 
a jury and sent here. They are classified in their wards according 
to their conduct. As I have stated you cannot make fish of this 
man and flesh of that man; we have no choice over the matter. Now 
this is the point I want to get at, that we believe we cure people 
here, we believe we are restoring them and I don't believe in that 
process of restoring people which compels them to rub up against 
murderers and touch hands with them day after day. I don't be- 
lieve they should go out from an institution of this kind, restored 
to their reason, and have had to associate and come in contact daily 
in the wards and corridors with those who have committed crime 
or with the man who was a little off and grew to manhood and after 
awhile a man crosses his path and he kills him. 

A Director. A good many of these people are not insane but 
make themselves out to be insane through the zeal of their lawyers 
who desire to have them cleared of the penalty that is attached to 
their crime. 

Mr. Snyder. Have you ever looked up the statistics as to their 
number? 

Dr. Mayberry. There would be from 200 to 250 of the two classes 
together. 

Mr. Snyder. How many have they at Matteawan? 

Dr. Mayberry. Six or seven hundred; they include the two classes. 

Mr. Butler. We have a man here by the name of John O'Day who 
went out on the platform of the Lehigh station and killed a man 
and woman and he is no different than he was twenty years ago, 
and if I was in there, or your brother was in there, he would be asso- 
ciated and classified right by his side and I claim that it is not right 
but that there should be a separate place for criminals. 

Dr. Mayberry. I was called by the district attorney in that case 
and after making a careful examination I had to declare that he 
was insane. 

Mr. Butler. I am not criticizing the position of the doctor for 
no doubt he did what he felt it to be his duty to do ; I only desire to 
call attention to the circumstances that exist in our present system. 

Mr. Anderson. Your objection is to placing them together? 

Mr. Butler. Yes, sir; there should be a line of demarcation and 
they should be treated separately and treated humanely, of course, 
but not in association with pedjjje who never had an unkind thought 
towards anybody. I say that they should be put in a separate 
building; put them here, if you please, but put them in a separate 



315 

building. In fact, I do not see that there is an argument on the 
other side. After a man has gone through the hands of a jury 
and been acquitted on the ground of insanity, or has been before a 
judge and a commission of lunacy, the man having committed a 
crime, we can fix the degree of crime and it seems to me there ought 
to be a law where he would be taken care of among a class of that 
kind. 

Mr. Snyder. That man O'Day was perhaps like the old doctor 
who was called as a witness in the Guiteau trial. He was asked 
whether he (Guiteau) was deranged and he said: "No," he never 
thought he was deranged but that he was very badly arranged. 

Dr. Mayberry. He would be classed now as a paranoia and so 
would Prendergast be known as such among alienists. 

Mr. Snyder. In order to have a man discharged, for instance if 
John O'Day asked to be discharged, he would have to go to the 
Lunacy Board would he not? 

Dr. Mayberry. No, sir; he would have to go to the court and then 
have to be returned to the jail. 

Mr. Snyder. I think it is pretty generally admitted that there 
should be a hospital of some kind for the criminal insane. 

Mr. Butler. That is the only thing I can see, under the system 
we are working, that we lack and we lack it because we are a 
hospital for the treatment and cure of the insane and we send out 
every day or so a man cured and I do abhor the fact, I don't care 
who it is, that he should have to associate three weeks, three months 
or six months in a ward with a man who has taken a life or com- 
mitted crime. I may be sentimental on this subject but I am 
deeply interested in that which I have stated. 

Mr. Snyder. 1 don't think you are; I think you are about right. 
You take a man who has sensitive nervous system, and possibly 
has a history of some of his family being a little melancholy at 
times; he has been nicely and carefully raised and sometime he 
becomes a little insane and he has to go in an asylum and associate 
with the worst criminal in a county and it certainly does not seem 
to be the proper thing to place him among the criminal class. 

Mr. Butler. We have a man here now from our town, as nice 
and fine a gentleman as any one in this room and he is in the ward 
with this insane murderer, his wife is here to-day with him and he 
is required to live here six months, or maybe longer, with such a 
man as a criminal and I venture to say that he does not like it, nor 
does his friends. 

A Director. You place a patient of that character among them 
and they do not know whether they are going to kill any one or not 
and in some cases it may be a very dangerous thing to do. 



316 

Mr. Heidelbaugli. In regard to building this institution, when you 
built it did you find your taxpayers complain much about the taxes? 

Mr. Butler. There are about twenty municipalities in this dis- 
trict, consisting of the city of Wilkes-Barre and some towns and 
townships and the population is about 145,000 in the district. The 
insane of those municipalities are taken in for care and mainte- 
nance at this institution. With reference to the taxpayers, we 
were going on and doing all our work limited to 10 mills. Without 
the consent of the people we raised it half a mill and we are 
swimming along nicely on that half mill additional and the doctor 
here, after awhile, will be able to lower it. I think we have the 
summit of the millage. The real value of this district is five times 
the assessed value. You will understand that there is a great deal 
of mineral and coal lands in the district and the large corporations 
pay a large percentage of these taxes, for instances such corporations 
as the Delaware and Lackawanna, Lehigh Valley, Susquehanna Coal 
Company and a number of others and the men representing these 
companies are watching and scrutinizing everything that is being 
done and have a taxpayers' association; they pay seventy-five per 
cent, of all this and they watch and scrutinize everything and have 
a system of audit and never have we had a voice raised about ex- 
travagance; there has never been any criticism of our method or 
management. There is one thing about our district which may be 
peculiar and I wish to state it, that we have a man on the board 
appointed by the court in 1863, and is on the board yet; he will 
complete a service on this board of forty years in January next; he 
is the president of the First National Bank in Wilkes-Barre, a 
director in the Lehigh Valley Railroad Company and largely inter- 
ested in almost all important business in the valley — he is not 
here to-day. The term of our office is five years. The court has 
never turned him down and will not let him go as long as he is 
willing to served Every year he wants to go off the board but they 
keep him and do not wish to let him retire. I never heard of a man 
who criticised the tax levy of the poor district. The assessed val- 
uation placed on an ordinary man, who used to be denominated 
a yeoman and now denominated a laborer, miner or mechanic, is 
thirty dollars, and fifteen cents pays his poor tax on our levy and 
the masses of the people who are supposed to be least able to pay 
therefore contribute the sum of fifteen cents a year and it amounts 
to about twelve cents when we get it. 

A Director. We also give out a big lot of outside relief. I would 
like very much to see the Legislature tackle that question of sepa- 
rate confinement for the criminal insane. I think the State of Penn- 
sylvania should tackle that question and do something. 



317 

Dr. Mayberry. The aspect of the case that I have been most in- 
terested in is the care and cure of the curable insane. 

Mr. Butler. Just one more thought I would like to advance: The 
central poor district of Luzerne County was created in 1860, and 
started out with the Wilkesbarre township and it is so arranged that 
any township that wants to become a member of this district, on 
the consent of the township, they may become annexed and they are 
grouped around in a number of townships and grouped into a number 
of boroughs. They represent all the boroughs on each side and 
townships up to Pittston and then comes in the Pittston district 
and there comes in a number of townships. Under our system and 
the laws which created the district the directors are appointed by 
the judge of the quarter sessions for five years and in that way our 
board is created representing every section of the district. We 
will oppose any attempt to change those laws and put the control 
of this institution into the hands of the county commissioners. If 
we had more time we would like to go into details more fully in 
order to show why we have a large benefit and a greater advantage 
over anything else that possibly could be given us. One of the 
peculiar features of the whole thing is this, that if we to-day stood 
here as elected, or if we were under the control of the county com- 
missioners, among this foreign population in Luzerne county, the 
taxpayers would be mulcted in the expenditure of a much larger 
amount for the support of this institution and I could not say 
where it would stop. For instance, take the strike that exists 
to-day, if the opportunity were given under different conditions 
there would be many who would dribble at this crib until it would 
be ruined. There are a class of people who would go to work and 
work for a time and then go on a strike and the taxpayers would pay 
the bill and therefore I say we do not want to be disturbed. 

Mr. Snyder. I do not contemplate that there would be any law 
passed to disturb these districts that are already established. 
There might be some law passed in which some of your patients 
would be taken away; for instance, the criminal insane, the epilep- 
tics and that class. 

Mr. Butler. There is only one proposition: First, the method of 
putting the officers in power through the court, through the judges; 
second, the power of taxation; they are limited to ten mills but 
we are going half a mill above that. 

Mr. Heidelbaugh. You don't want yonr special law repealed? 

Mr. Butler. No, sir; we do not. We are all unanimous on that 
here, taxpayers and everybody. We have no politics in it here at all. 

A Director. That is what we will get if it is put into the hands 
of the county commissioners and so long as it is kept out of their 
hands politics will not be mixed in it. 



318 



Mr. Heidelbaugh. Can you order a building here without the con- 
sent of the county commissioners? 

Mr. Butler. Yes, sir; they have no control over us at all; we are 
an independent corporation made up from the city of Wilkes-Barre 
and a number of towns and townships, made up and bundled to- 
gether and through that different localities have representation on 
the board of directors; the city of Wilkes-Barre gets two representa- 
tives, Plymouth, Newport and Hanover, Kingston, and the like all 
get representation. 

Mr. Snyder. When you make your requisition you make it on the 
county treasurer? 

Mr. Butler. No, sir; we sit down here and levy our own millage. 
If we want to make it five and a half per cent, we make it so. 

Mr. Snyder. You are a law unto yourself? 

Mr. Butler. Yes, sir. 

Mr. Snyder. The court appoints the directors and you make your 
own by-laws? 

Mr. Butler. Yes, sir. 

Mr. Snyder. And you levy your own tax rate? 

Mr. Butler. Yes, sir; we appoint our tax collectors and settle 
with them. The auditors of those boroughs, townships and the 
city of Wilkes-Barre come in and sit around our table and the ac- 
counts are gone over and w r e find that this system has worked very 
satisfactorily among us. 

Mr. Snyder. You are your own boss of your district just the same 
as the county commissioners are of a county? 

Mr. Butler. Yes, sir. 



LEGISLATIVE COMMISSION TO INQUIRE INTO THE CON- 
DITION OF PENNSYLVANIA INSANE. 



Inspection of the County Insane Hospitals in 

Wisconsin. 



September 6th to 13th, 1902 



(319) 







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321 



VISIT TO COUNTY INSANE ASYLUMS IN WISCONSIN. 



The Commission visited the state of Wisconsin from September 
6th to 13th. They were received at Madison by the members of 
the State Board of Control, viz: Judge Wm. P. Lyon, president of 
the board; N. B. Treat, vice president; Messrs. Herman Grotophorst, 
Gustav Kustermann, Andrew G. Nelson and M. J. Tappins, sec- 
retary. 

At a meeting held in the board room, it was decided that the 
Commission, accompanied by members of the Wisconsin State Board 
of Control, should first visit the Dane County Asylum at Verona, 
and after that go to the State Hospital at Mendota, to be followed 
on Wednesday, September 10th, by a visit to the Milwaukee Hos- 
pital for the Insane, and also the County Hospital at Wauwatosa, 
and on Thursday, September 11th, by a visit to the Northern Hos- 
pital for the Insane, and the Winnebago County Asylum near Osh- 
kosh. 

At the Dane County Asylum at Verona, the Commission was 
accompanied by President W. P. Lyon and Mr. Gustav Kustermann, 
of the Board of Control. Mrs. Edwin, wife of the superintendent, 
escorted the party through the institution and showed the various 
wards. 

This asylum has a population of about one hundred and fifty quiet 
chronic insane patients. Most of the men are able to work on the 
farm, and the women patients are kept busy with sewing, and laun- 
dry and kitchen work. No restraint seemed to be exist, all the 
doors and windows were open and patients were allowed to go in 
and out at will. 

The average number of attendants at this county institution is 
one to twenty, and the doctor, who resides about a mile from the 
institution, is compelled to make two professional visits to the insti- 
tution each week, for which he receives two dollars per visit. In 
addition to this there is a superintendent, a matron, a bookkeeper, 
three male attendants, three female attendants, cook, laundress, 
assistant farm hand, male night watch and female night watch. 
The wards and building seemed to be very well cared for. The 
patients eat in a general dining room. No special provision is made 
for dancing, the class of patients being mainly of the older chronic 
class, who do not seem to require this kind of amusement, but 
21 



322 

musical and similar entertainments are given occasionally, but 
with no regularity. 

The Commission visited the State Hospital for the Insane at 
Mendota, and were met by Dr. Ernest Bullard, superintendent, and 
his associate physicians. At this hospital acute and some chronic 
insane are kept. Enough to help do the work around the grounds 
and buildings are thus employed. Here are also some of the dan- 
gerous classes and those which need constant medical treatment, as 
the latter could not be kept in the county asylums. The popula- 
tion of this institution is constantly changing, as all classes of 
patients are received from all over the State, and from this insti- 
tution are distributed to the different county institutions through 
the orders of the Board of Control. This hospital, however, is 
mainly intended for the acute curable cases, and usually patients 
that are not cured within a year and are not dangerous are trans- 
ferred to the county asylums nearest their homes. 

All modern appliances are in use at the institution. 

This hospital has room for about four hundred and fifty patients. 
The ratio of attendants to patients is one to six, and the per capita 
cost is $4.30 per week. 

It is the opinion of Dr. Bullard that the noisy and violent insane 
should be separated from the quieter patients, and that criminal in- 
sane should be separated from the other class entirely. 

After returning to Madison in the evening the Commission met 
President Lyon, the secretary and several members of the Board, 
and the following questions were asked and answered: 

Q. Are any female physicians employed in any of the hospitals or 
asylums? 

A. Only one at the Northern State Hospital. At Mendota the 
plan has been tried, but with no success, as the lady in question did 
not wish the superintendent to issue any orders or to have any 
communication with her nurses or attendants, except through her- 
self. 

Q. When was the county care act passed by the Legislature? 

A. The county care system of Wisconsin has been in existence 
since 1880, at the time when the act was first passed. The state 
in order to induce the counties to build asylums and take care of 
their own insane, offered to pay one-half the cost of the buildings, 
but this act was afterwards repealed, and another passed, in which 
the counties were authorized to build their own asylums and re- 
ceive (in lieu of half the cost of erecting the buildings), $1.50 per 
week for the maintenance of patients — that is, when the patients 
were residents of the same county in which the asylum was located. 
If he (or she) was a resident of another county then the State under- 



323 

took to pay the county 13.00 per week and the cost of clothing, 
and to collect from the county of which the patient had been a 
resident, $1.50 per week, and the cost of clothing. If the patient 
had no known residence in the state, then the state paid $3.00 per 
week and the cost of clothing to the asylum to which the patient 
has been assigned. 

Q. Do you have any paid patients? 

A. Some, and charge about $6.00 per week. The Board of Control 
is now asking for an appropriation from the Legislature to build an 
asylum for the criminal insane. 

Q. Is there any danger of politics creeping into the management 
of the county institutions? 

A. No, the Board does not favor political management of the in- 
stitution. 

Q. Have you ever tried to have three or four counties join to- 
gether and build an asylum? 

A. Yes, we have tried this but with no success. As a rule, coun- 
ties do not agree, and have in all instances built separate asylums. 

Q. Under county care system, does it not create a desire to make 
money, and deprive the patients of proper care? 

A. It would, but as the Board of Control has absolute control, it 
can empty the institution immediately if necessary, if any abuse 
occurs. The Board can withhold the $1.50 per w 7 eek from the 
state and remove patients w 7 hich belong to another county from 
the institution to another and in this way compel the counties to 
take proper care of their patients. The State Board of Control has 
absolute authority over county institutions so as to see that no 
abuse occurs. Another advantage of the county system is that 
taxpayers of a county in which an institution is located, will pay 
more taxes for maintenance, etc., than they would for state insti- 
tutions, and naturally take more interest in them, and as a rule, 
pay more visits to the asylum. 

The taxpayers of counties where asylums are located have abso- 
lute power over them as long as everything is done right, but the 
State Board of Control must visit these county institutions once 
in every three months, and inspect them to see that they comply 
w r ith the law, and that no abuses occur. A county in order to build 
an asylum must first have the consent of the Board of Control, and 
submit the plans and specifications to the Board of Control and 
have them approved before they can build an asylum. 

The Board of Control consists of five members, appointed by the 
Governor (by and with the consent of the Senate) for a term of 
five years from date of their appointment, but no two can be from 
the same congressional district, and not all of whom shall belong 



324 

to the same political party. The members each receive $2,000 per 
year and all actual necessary expenses, and must devote their 
entire time and attention to the discharge of their duties. The 
Board may employ a secretary, two clerks and stenographer, and 
elect from its number a president. The secretary receives $2,000 
per year, the same as the members and must be a competent and 
experienced bookkeeper. 

The Board is compelled by law to visit the institutions in the state 
once in every three months, either as a body or by some member, 
or members, and has power to remove any officer, etc., for misbe- 
havior, or neglect of duty. They appoint annually for each hos- 
pital for the insane, a superintendent, assistant physician, a matron 
and steward, and all necessary officers for state institutions. 

The Board has power to remove inmates from one institution, 
either state or county, to any other institution, with the exception 
of persons committed by the courts awaiting trial or sentence 
for felony. 

The Commission visited the Milwaukee Hospital for the Insane 
at Wauwatosa on Wednesday, September 10th, and were received 
by the superintendent, M. J. White, M. D., and Mr. Hopkins, presi- 
dent of the board of directors. 

This hospital, under a special act, is allowed to treat acute insane 
patients the same as state hospitals, for which it receives from the 
state $3.50 per capita, and for the chronic class it receives $1.50, 
the same as other county hospitals. 

The hospital is thoroughly equipped and has a full corps of phy 
sicians and nurses, and is governed by the same rules that govern 
the other county hospitals. Under a special law this hospital is 
allowed seven directors, appointed by the Governor, to serve for a 
term of seven years, while other county hospitals only have three 
directors. These directors for county hospitals are not confined to 
men of any one particular party, but are men that are the best repre- 
sentative citizens of the respective counties and are usually chosen 
from their fitness for the office. 

This hospital accommodates about 530 patients, some of whom are 
chronic insane. Enough of this class are kept to help around the 
institution and grounds and reduce the cost of maintenance. The 
rest are acute, of the same general class of patients which make up 
the population of all institutions of this character. 

The hospital has a central dining room, where all patients are 
fed that are physically and mentally able to be taken to the dining 
room. The rest are fed in the wards. 

Some of the violent patients are fastened in their rooms at night. 
This seemed wrong to the Pennsylvania Commissioners, as in the 



325 

case of fire there would be no possible chance of escape, as all the 
windows are covered with ion gratings, and the windows are of 
heavy plate glass. The superintendent has obviated this, however, 
by having electric wires run through the wards, and in some manner 
connected with the lock of all the doors, so that by turning a 
switch he can unlock all doors which cannot be closed again while 
the sw T itch remains in place. This switch can be operated either 
from the ward or the office. 

The porches of this hospital are fitted up with glass roofs and 
sides, and heated the same as the rest of the building. These are 
used for patients as sun parlors, etc., and are so arranged that chairs 
or beds can be rolled into them from the wards. 

The Commission then visited the Milwaukee County Asylum. This 
is at Wauwatosa, near the insane asylum, but not under the same 
management, and only .receives the chronic patients from the county 
and some state at large patients that are chronics. This asylum 
unlike most of the others, has a physician as superintendent, while 
most of the others have to call the doctor by telephone in cases of 
emergency. The Commission were shown through the wards and 
sleeping rooms. No patients were in the building, all being out 
around the grounds. Here the superintendent's house was con- 
structed and finished entirely by the patients, and show 7 s that excel- 
lent work can be done by employing the inmates under proper super- 
vision. 

On Thursday, September 11th, the Commission visited the North- 
ern Hospital at Oshkosh, and w 7 ere met by the superintendent, Dr. 
W. A. Gordon, who kindly took the Commission in charge and 
showed them through the various wards connected with the hos- 
pital. 

The hospital is different in some respects from any hospital the 
Commission had visited thus far. Before a patient is taken to the 
hospital proper he is taken to a small building several hundred feet 
distant. Here he is examined and thoroughly washed, and clothes 
cleaned. He is then afterwards taken to the main building and 
put into the proper ward. 

Under the direction of Dr. Gordon the Commission was taken 
through the different wards of the hospital. They were shown the 
"massage" room. This room was thoroughly fitted up for the pur- 
pose for giving hot and cold baths. They were shown the barber 
shop. This is a large room, and is w 7 ell lighted. Here are located 
the steam baths. These are boxes with coils of pipe in them, and 
closed with two wooden covers, with an opening large enough for 
a man to put his head out of them. They are heated to any desired 
temperature. Electric baths have also been built with a number 



326 

of incandescent lamp globes in them, which supply electrical heat for 
curative purposes. In the room adjoining salt baths are given, as 
prescribed by the physicians. 

While this is an old institution in point of years, it is not so in 
service, as all new ideas and appliances are added as they become 
necessary. 

The shower bath system has been installed, and gives good satis- 
faction. This is the most modern way of bathing patients, as it is 
much quicker and better, and no patient can use the water the 
second time. A new operating room has just been added to the 
institution. In some of the wards rooms have been constructed 
with false floors with steam pipes under them. These are for pa- 
tients who will not keep their clothing on and who also have a 
tendency to destroy everything portable within their reach. This 
plan enables them to be on the floor without catching cold. 

In some of the violent wards Dr. Gordon has women attendants. 
This has had a good effect as the women attendants get along better 
with the patients than men. About the usual number of patients 
are employed, but the number of attendants to patients is about 
one to three and a half. This may seem large, but not when it is 
considered that this hospital only treats acute cases. 

The dining room where all the patients are fed is also used as 
the hall for the entertainments, and has a stage in one end. When 
the patients have an entertainment or dance they move the tables 
and chairs out into the halls. On the upper floors rooms have been 
fitted up where singing and other branches are taught. By these 
means the patients are constantly kept doing something, and in some 
instances foreign born patients have obtained valuable knowledge 
of the English language and are thus easier to control. 

Like hospitals in Pennsylvania, both convict and criminal insane 
are received. These classes of patients seem to be a great annoy- 
ance to the superintendents generally. 

Dr. Gordon does not approve of the use of much meat, and has 
curtailed the use of coffee and tea, with beneficial results to the 
patients. 

The following dietry list will show how the patients were fed dur- 
ing the week the Commission visited the hospital: 



Diet List for the Week Ending September 6, 1902. 

Sunday. 

Breakfast — Water melon, potatoes, syrup, bread, butter, coffee, 
cake, radishes, beet pickles, rolled wheat. 



327 

Dinner — Eoast pork, gravy, potatoes, bread, chili sauce, beet 
pickles, green corn, green apple pie. 

Supper — Hominy and milk, bread, butter, syrup, cake, apple sauce, 
green corn. 

Monday. 

Breakfast — Codfish, gravy, potatoes, bread, butter, coffee, corn 
meal gems, syrup, cheese, beet pickles, oat meal. 

Dinner — Vegetable soup, crackers, boiled beef, potatoes, bread, 
butter, sliced cucumbers, hot slaw, bread pudding. 

Supper — Cod fish, gravy, cocoa, bread, butter, sliced tomatoes, 
ginger cake, hot slaw. 

Tuesday. 

Breakfast — Sliced tomatoes, corn meal gems, syrup, coffee, bread, 
potatoes, butter, apple sauce, boiled rice. 

Dinner — Fried onions, syrup, chili sauce, bread, butter, sliced cu- 
cumbers, carrots, potatoes, corn beef, cold slaw. 

Supper — Bread, butter, tea, corn meal gems, sliced tomatoes, 
stewed onions, carrots, cold meat, syrup. 



Wednesday. 

Breakfast — Hash, bread, butter, syrup, coffee, cheese, oat meal, 
sliced tomatoes, cold slaw. 

Dinner — Turnips, bread, picalilli, butter, squash, green apple pie, 
baked beans, green corn. 

Supper — Mush and milk, bread, butter, syrup, coffee cake, sliced 
tomatoes. 

Thursday. 

Breakfast — Hash, bread, butter, corn meal gems, syrup, coffee, 
cheese, oat meal, apple sauce, sliced tomatoes. 

Dinner — Roast beef, gravy, potatoes, bread, sliced cucumbers, 
boiled onions, hot slaw, beet pickles. 

Supper — Meat stew, fried potatoes, tea, bread, butter, buns, toma- 
toes, stewed onions, hot slaw. 



Friday. 

Breakfast — Codfish and gravy, bread, butter, syrup, coffee, corn 
meal gems, sliced onions. 



328 

Dinner — Fish turbot, potatoes, bread, butter, syrup, greeja. corn, 
turnips, sliced onions. 

Supper — Bean soup, cocoa, pickles, ginger bread, butter, syrup, 
cold slaw, sliced tomatoes. 



Saturday. 

Breakfast — Potatoes, bread, butter, coffee, doughnuts, syrup, apple 
sauce, boiled rice. 

Dinner — Mutton stew, potatoes, bread, syrup, string beans, cold 
slaw. 

Supper — Mutton stew, cocoa, ginger snaps, sliced tomatoes, syrup, 
cold mutton, string beans, cold slaw. 

This hospital has about six hundred patients, and costs about 
f 4.00 per capita per week to run. 

The Commission then went to the Winnebago County Asylum, 
which is situated but a short distance from the Northern Hospital. 
This, like most of the other county institutions, has no doctor con- 
nected with it, but one that lives at Oshkosh, about two miles away. 
The doctor makes two professional visits each week, and others 
when necessary, for which he receives $2.00 per visit. This asylum 
like the others, contains a few patients who require watching, and 
to be kept in the ward during the day, but most of the patients 
were out, working on the farms. As usual the doors and windows 
were all open and the patients allowed to go in and out at will. 



SUMMARY OF THE WISCONSIN SYSTEM. 



The Pennsylvania Commission found upon arriving in Wisconsin 
that the so-called cottage system in the various counties of the state 
had been carried on for a number of years. It may be expedient 
at this point to present a summary of the system as it now exists 
in Wisconsin. 

The State Board of Control of Wisconsin consists of five members, 
who are appointed by the Governor of the state, and who have 
entire and absolute charge of the penal and charitable institutions 
of the Commonwealth. Under general laws this State Board has 
power to establish county hospitals wherever it sees fit. Of these 
institutions thirty have up to this date been authorized, constructed 



329 

and put into operation. For each inmate of a county asylum the 
state of Wisconsin pays the county $1.50 a week. The county insti- 
tutions are supervised by the State Board, which makes all the 
rules and regulations for their government. The trustees and su- 
perintendents of the county institutions are generally selected from 
the most promient men in each county. Politics does not enter 
into the question of their appointment. The local boards and the 
State Board have in almost every instance worked in complete 
harmony. 

There are three local trustees in each county, who are elected by 
the county board of supervisors, and these trustees appoint the 
superintendent. The State Board of Control is compelled by law 
to visit and inspect these county asylums at least once every ninety 
days, but apart from this requirement frequent visits are actually 
made without notice, and at all times of the day. In the event of 
there being any defect or mismanagement of a county institution 
the State Board has it in its power to instantly transfer the insane 
to some other asylum, and to withhold all payments of state money 
to the delinquent institution. 

Under general regulations the State Board has limited the ca- 
pacity of the local asylums to between one hundred and one hundred 
and twenty-five. It is claimed by those who favor the Wisconsin 
system, that the local institutions afford more freedom of action 
to the lunatics than do the larger state institutions, and that the 
farms, containing from one to six hundred acres each, provide ample 
employment for the men, while the kitchen, laundry and sewing 
room fill up the time of the women. The combined area of the farms 
belonging to the county asylums is over 6,000 acres of fine land. 

While it is true that many of these county asylums are associated 
with almshouses it is also true that the insane and the paupers 
do not eat together, nor mingle together to any extent. 

Some of the newer local institutions are beautiful structures, 
finished in hard wood, lighted by electricity, heated by steam, and 
with an abundance of water for all purposes. No provision is made 
at them, however, for medical treatment, beyond the occurence of 
ordinary diseases. A physician is appointed for each asylum, who 
visits the same at regular and stated intervals, once or twice a 
week, and there are hospital rooms in each of the institutions, but 
there is no absolute effort to cure the insane by any specific system 
of medical treatment. The inmates have almost perfect liberty, 
open doors, no restraints of any kind and a general dining room. 



330 

The following blank forms show the character of the reports which 
the State Board of Wisconsin exacts from the county institutions: 

MONTHLY REPORT 



County Asylum for the Chronic Insane, 

For the Month of 190. 



I hereby certify that the following report is correct, according 
to the best of my knowledge and belief. 



Superintendent of County Asylum. 



General Report. 



1. Give any changes in buildings or furniture this month 

2. Give any changes in methods of managing insane this month 

(Especially state any additions to the liberty or occupation of the inmates, any 
improvements in food or clothing, and any special efforts for individual or experi- 
ments with them.) 



3. How many inmates are now on parole to go around without an attendant 

4. Give a list of those now absent on leave, with the time each has been so absent 

(Among these should be given those who have escaped, whom you suffer to stay 
away knowing where they are, although no formal leave of absence has been given 
them.) 



What inmates could in your judgment go home, if they had a good home to go to' 



6. Do you have a common dining room for all the inmates' 

7. Which inmates do not eat at the table and why? 



8. How many visitors have you had the past month? 

9. What amusements, religious services, etc., have you had for the inmates the past month? 



10. Please note here any changes in trustees, or in the system of business management of 
the asylum, 



11. How many visits has the asylum physician made during month?. 



331 

Summary of Population. 



1. Total number at close of last month, 

2. Admitted during month 

3. Inmates returned (whether escaped or absent on leave), 



5. Discharged during month on re-examination of sanity , 

6. Paroled during month, 

7. Died during month, 

8. Transferred to other institutions during month, 

9. Escaped during month 

10. Gone away on leave of absence during month 

11. Total loss of population 

12. Population at close of month. (This should exactly equal 

the difference between lines 4 and 11), 



Male. 



Total. 



13. Discharged by reason of two years continued absence on 
parole under Section 587c, R. S., amended by Chapter 327, 
Laws of 1899 



14. Amount of board furnished inmates kept at private charge, 

15. Amount of board furnished inmates kept at the charge of 

this county 



16. Amount of board furnished inmates for the following named 
counties: 



county, 

county, 

county, 

county, 

17. Total amount of board furnished all inmates, 



No. In- 
mates. 



Days. 



332 



Statistics of Occupation and Restraint. 



Occupation. 


Persons Employed. 


Time in Days Actually 

Employed. 


Male. 


Female. 


Total. 


Male. 


Female. 


Total. " 


1. Number who generally work 














2. Number who generally work 














3. Number who work less than 




























5. Of these last how many are 
physically disabled, aside 
from their mental in- 




























(Not the cash value of 
the labor, but the 
amount of time should 
be reported.) 

RESTRAINT AND SECLUSION. 
1. Number who have been in restraint or seclusion all the 




2. Number who have been temporarily in restraint or se- 








3. Number not in restraint or seclusion during the n 


lonth 






t exactly), 

at night 
tement in 








The presence of an attendant oi 
should not be considered a 
Restraint Book.) 


the locking of doors 
restraint. (See sta 









Admissions and Returned Inmates. 



Total number since October 
1. last. 


a 
o 

E 

O 

>> 

a 
Q 


NAMES. 
(In order of time.) 


< 


>> 

c 

3 
o 
O 

QJ 
O 

a 

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'w 
<p 
P5 


When committed and by 
whom. (If returned from 
hospital that fact is suf- 
ficient with the date.) 


Remarks. (Note. — Escaped 
inmates and absent on 
leefve returned, all those 
kept at private costs, and 
all items of interest re- 
specting each person.) 


! 








! 












! 





































































































333 



Deaths, Discharges, Escapes, or Absences on Leave. 













t-i 














o 




£ 
























13 














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o 














o> 








>> 




















c 








c 


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no 




NAMES. 




3 






(D 

a 
3 *j 


c 

o 

a 


(In order of time.) 




U 

a; 
o 




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c $ 








C 


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rt 


cd 


>> 




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tfi 


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Capacity. 



How many additional insane persons can you now receive without overcrowding your asylum? 
Males ; Females. 



Kestraint and Seclusion. 

(See statement in restraint book.) (If no restraints have been used, say No Retraints.) 



h 
































& 


























>o 






















o 












+j 












a 


c 

o 
o 


'3 




DQ 




NAMES. 




03 




m 




F-i 
0) 




(In order of time.) 






a 


u 




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<u 




u 




a 








Si 


<H 


tM 




3 -J 
















S 8 








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— — 









































































































334 



Pay Roll. 

(Fill out each month in full and foot up actual amount of salary.) 



Position, 


Names. 


Length of service in this ca- 
pacity. (Add length of ser- 
vice in any other capacity 
in parenthesis.) 


Rate of salary by year, 
month or week (including 
salary at poorhouse if also 
employed there.) 


Actual amount of salary 
charged to asylum for this 
month. 


Remarks. 


1 
Superintendent, 










Assistant Superintendent, 










Matron, 




. 








Visiting physician, 










Male attendant, 










Male attendant, 










Male attendant, 










Female attendant, 










Female attendant, 










Female attendant, 










Cook, 










Laundress, 












Engineer, 






1 






Farm hand, 




j 




Night watch, 






! 






















Total amount pay roll, 










j 














VISIT OF THE LEGISLATIVE COMMISSION TO 
INQUIRE INTO THE CONDITION OF THE 
PENNSYLVANIA INSANE 



TO THE 

Chester County Hospital for the Insane on Saturday, 
September 20, 1902. 



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LEGISLATION COMMISSION VISITED THE CHESTER COUNTY 
HOSPITAL FOR THE INSANE AT EMBREVILLE ON SATUR- 
DAY, SEPTEMBER 20, 1902. 



The hospital is located six miles from West Chester, the county 
seat of Chester county. The Commission were conveyed to the in- 
stitution in carriages furnished by the institution. On the arrival 
at the institution they were met by Dr. Jane R. Baker, superintend- 
ent, together with Mr. Davis Garrett, steward of the almshouse, and 
Messrs. J. Preston Thomas, John R. Smith and Dr. P. J. Nichols, 
directors. 

The buildings are located on a high eminence, from which a fine 
view of the surrounding country is afforded. There is connected 
with the institution four hundred acres of land, regular farming 
operations being conducted under the supervision of Mr. Garrett. 
Provisions are thus furnished to both the almshouse and hospital for 
the insane, and by this means some concession is made with refer- 
ence to prices at which necessary products are obtained. 

A tour of inspection was immediately commenced through the 
Hospital for the Insane, the Commission being conducted to the 
dining room, where the males were seated on one side and the females 
on the other of the main aisle. The tables were decorated with 
flowers grown principally by the inmates and arranged by the at- 
tendants. A second visit was made to the dining room when the 
inmates were seated at dinner. 

The men's wards were visited and everything found to be in a 
neat and tidy condition. In this department were the bath rooms 
and water closets; are supplied with automatic flush and a gravity 
supply of water, the water supply being furnished entirely from the 
land belonging to the institution. There is also a room for shower 
baths, with hot and cold water arranged so as to regulate the tem- 
perature by means of a thermometer registering the degree. There 
are also clothing rooms, dormitories, sitting rooms and billiard and 
amusement rooms. There is also in this department a commodious 
sitting room, and nowhere did there seem to be a crowded condition. 
The inmates make all the mattresses necessary for use in the two 
institutions and various other kinds of work are performed in this 
room relative to repairs incident to the institution. Adjoining this 
room is a carpenter shop. There are also sewing rooms, ironing 
rooms, rooms for keeping supplies and sick room. 

(337) 
22 



338 

After thoroughly inspecting the men's department a visit was 
made to the women's department, which is a counterpart of the men's 
department. The Commission was conducted through the various 
(halls, dormitories, bath rooms and sick room®. A visit was also 
made to the Chapel, which has a seating capacity of two hundred. 
Efforts are made to have religious exercises every Sabbath, and 
very often through the week the inmates are entertained with music 
by an orchestra of by a magic lantern exhibition. In the rear of 
the Chapel rooms are partitioned off for the accommodation of 
nurses. The construction of a Nurses' Home is in contemplation. 
This has been made possible by a bequest of six thousand dollars 
from a gentleman recently deceased. A draft was exhibited, show- 
ing full details of the proposed building. 

In passing through the halls, adjacent to the women's sleeping 
rooms, it was observed that some of them were decorated with flow- 
ers and pictures and that they were made to appear as homelike as 
possible. The building itself is substantially constructed as a fire- 
proof building. The fire escapes were examined by the Commission. 
Of these there are two on the men's ward and one on the women's 
ward, which open into the corridor from each floor by an outside 
door, having electric lights under them. 

Among the rules governing the institution is one providing that 
whenever an attendant should strike a patient he or she should be 
immediately dismissed and never re-instated. The women inmates 
make their own clothing and the men's underclothing. 

Leading from the Insane Hospital building to the almshouse 
there is a wide concrete w T alk under which is a passage-way for the 
conducting of pipes in heating the buildings. A pest house build- 
ing has been erected for diptheria cases and also one for the insola- 
tion of small pox cases. There were four cases of small pox on the 
premises last year, but at present the institution is free from any 
contagious disease. 

It was noticeable at this institution( more than any other of a 
similar character visited by the Commission) that a larger number 
of the inmates consisted of colored people. The Commission were 
introduced to a colored man nominally 102 years of age. Tt was 
stated that the almshouse, established at this place, was the second 
in the State of Pennsylvania, dating back to the year 1797, thot in 
Philadelphia being the first. The following questions were pro- 
pounded to Dr. Jane K. Baker, superintendent of the Hospital for 
the Insane and physician to both the hospital and almshouse pa- 
tients : 

Dr. Jane R. Baker examined and testifies as follows: 
Examination conducted by Mr. Snyder, Chairman of Commis- 
sion. 



339 

Q. Will you please give us the number of patients in the Hospital 
for the Insane at this time? 

A. One hundred and eighty-four. 

Q. How many females? 

A. One hundred and three males and the rest females. 

Q. How many patients have you proper accommodations for? 

A. We have not any too many patients for the buildings. We 
count 500 cubic feet air space to the patient and taking that basil? 
our hospital is not OA 7 ercrowded; it is full but not crowded, it is com 
fortable. 

Q. Can you give us about the number of minors in the institution, 
of male and female together? 

A. We have about three. 

Q. How many epileptics have you in the institution? 

A. We have from ten to fifteen. 

Q. Do you attend the patient® here when they get sick? 

A. Yes, sir. 

Q. How many epileptics are there in the almshouse proper? 

A. About fifteen. 

Q. I noticed quite a number of feeble-minded, how many of them 
do you have in the almshouse proper? 

A. More than half of our inmates are feeble-minded from age or 
birth. 

Q. How many are there, from their history, that were born de- 
fective? 

A. Half of our population were born defective, either morally or 
mentally defective; that includes our girls not fit to send out and 
bad children who are really defective mentally. 

Q. Among the chronic or hopeless cases, about what precentage 
of your patient® in the insane department are hopeless or chronic? 

A. Out of the 184 cases, if you take 30 out you will cover all that 
will ever leave here. 

Q. That is, there will be 150 chronic cases? 

A. Yes, sir. 

Q. How many violent cases have you? ' 

A. We have only what I would consider about four cases; those 
are only so periodically. Of course we have others that will slap 
you in the face, but we have four that are really voilent eases. 

Q. How many criminal insane do you have? 

A. Eight. 

Q. Are they cases that have been convicted before a court, or are 
they cases which have not been tried? 

A. They all have been convicted before the court and turned over 
to the hospital by order of the court because of their mental condi- 
tion, it having been decided that thev were insane. 



■ 



340 

Q. Insane convicts? 

A. Yes, sir; but not convicts and then insane. Mahlon is here by 
order of the court. We have a man here by the name of Curley 
who burnt a house under some delusion as well as assaulted his 
wife, shot at her and was put in jail and afterwards sent here on the 
ground of insanity. 

Q. How many paid patients have you in the insane department? 

A, That is, patients paying $1.75 up? 

Q. Yes, sir. 

A. We have thirty who pay $1.75 up to $5.00; ten of those are 
private cases. 

Q. What is the whole number of paid employees in the institu- 
tion ? 

A. I have twenty-two. 

Q. What was the average cost per capita, per week, last year? 

A. $2.80; it will be less this year. 

Q. Everything you receive from the farm is charged to your insti- 
tution as if you were a separate institution? 

A. Y^es, sir; the same as if we were buying it from the outside. 

Mr. Smith: A good many thing®, such as the hauling of the coal, 
we do not charge anything and mechanics when employed for repairs 
we board here. 

Mr. Snyder, Chairman: If this place were located at a spot ac- 
cessible to the railroad, or you had a siding here, the hauling 
would not cost anything. At the Willard Hospital, in New York 
State, they have tracks running to all their buildings on the grounds 
of the institution. What would there be that you could get the 
advantage of, without having to pay for, outside of the hauling of the 
coal? 

Mr. Smith : The ice is not charged for and there is no expense for 
water. 

Dr. Baker: Our men help get the ice in. 

Mr. Snyder: If you were in some localities you would put an 
ice plant in; some institutions have their own ice plant, they have 
one at Retreat. If this institution was located where a modern 
institution should be located you would have a siding and tho ex- 
pense with reference to the hauling of coal would be cut out, but 
this institution was located and started, especially the almshouse 
part of it, long before the existence of railroads. 

Dr. Baker: This was in the middle of the two counties before 
Chester and Delaware were divided. The almshouse was built in 
1799. It is said to be the second almshouse established in the State 
of Pennsylvania. 

Q. (Mr. Snyder). What do you think of (having the epileptics sepa- 
rated from the other patients? 






341 

A. (Dr. Baker). It would be an advantage to the epileptics. 

Q. What would you say with reference to having the criminal in- 
sane and the insane convicts in separate institutions? 

A. From the experience I had in Massachusetts, the class that 
Ave get as criminal insane were very much better away from the 
others. My experience here has been the same. 

Q. Does not their association with the milder cases have a bad 
influence over them? 

A. It did, with the worst class of criminals, and I do not think 
it is right that the innocent insane should be compelled to associate 
with criminals, because I have patients here who are criminals be- 
cause they are insane. 

Q. Do you think they ought to be kept in one of those insane insti- 
tutions? 

A. No, sir; I don't think it is the place for them. 

Q. Don't you think they ought to be kept in an institution attached 
to the penitentiary? 

A. I think they ought to be attached to the workshop, as it is in 
Massachusetts, and there the insane and pauper turn up year after 
year. There is a good place for them to help support the others. 

Q. It is hardly right that you should be jailer as well as superin- 
tendent of the institution? 

A. No, sir; I don't think so. 

Q. There is a good deal of discussion now going on with refer- 
ence to having such an institution? 

A. In Massachusetts you have men coming into the poor house 
year after year and they are dressed up and sent out and often come 
back the third time; they are put to the workshop and the work 
house and the insane criminals live at the same place and they are 
a pretty good combination. 

Q. Would you provide differently for them in the cities than in 
the country districts, with reference to settlement? 

A. That is a pretty hard question to get at; in Massachusetts the 
man who has not gained a settlement goes to the State poor house 
or work house and it is a State affair. However, take the man that 
comes in here who is known as the yearly tramp and you would 
have to take them to your State institutions because they are worth- 
less and have no settlement anywhere. Every winter we support 
from thirty to sixty that do not belong to us. In Massachusetts 
such characters are sent to the State work house, but of course where 
the law is not the same it would be hard to do this. The men who 
can work have no business to be supported. There is need of a 
place in this State for the wandering men who turn up every winter. 
This character is a bad element in our Commonwealth and what to 
do with him is an unsettled question. 



342 

Q. He is likely to be a criminal whenever he can be? 

A. Yes, sir. This lady here to-day with me is in one of those 
institutions in Massachusetts and she states that in passing through 
the institution she met from fifteen to twenty of her old applicants 
for aid. That shows you that they turn up at almost any place and 
that they are at the right place when they are sent to the work 
shop. 

Q. What do you think of putting all the idiot® and imbeciles in 
a separate institution, such as at the Polk Institution for the Feeble- 
minded? 

A. Well, the defective children ought to go there; after they get 
to twenty-five, twenty-six or thirty years of age they ought to <;o 
to the county home and thus let other children have a chance to get 
into such institutions in their earlier years. 

Q. You cannot grade them as well in the county home as you can 
in the State institution? 

A. No, but they ought to be trained well enough by the time they 
get to be twenty-six years of age so that you could control them. Of 
course there are exceptional cases, but that gives you a chance for 
the younger children. We have children here that would be better 
at Elwyn; as I understand Elwyn is not a State institution, but a 
private institution. 

Q. The State gives aid to the institution, but it is a private institn 
tion? 

A. It seems to me they do not look enough at that as an educa- 
tional institution. When those children arrive at the age of twenty- 
five to thirty years of age they have been taught all that they can be 
taught. We have had children brought here who should have gone 
there. 

Q. In reference to county asylums, do you think in counties of less 
than one hundred thousand population it w r ould be as practical to 
maintain them in county institutions as in State institutions? 

A. I don't think so. 

Q. How many patients could you take care of in a county institu- 
tion, such as you have here, to advantage? 

A. When a hospital gets over five hundred it is too large for the 
benefit of the patient; that is my personal judgment. 

Q. Could you take care of five hundred if you had them here, could 
you take care of them as well as the 184 that you now have? 

A. No, sir. 

Q. You could not take care of them and have as many cures as you 
have now, could not have as many patients that you considered cured 
when discharged? 

A. Well, I base my opinion on what I have observed : I have been 



343 

where they had five hundred and where they had one thousand, and 
I know of others larger, and my experience has been that where we 
had five hundred we did better work. 

Q. It has been your experience that you did better work where you 
had a smaller number? 

A. Yes, sir; I think in a smaller number you can give them better 
attention and in my judgment five hundred ought to be the limit. 

Q. I will put a hypothetical question to you : Suppose you had all 
the money at your command, that you desired, how would you regu- 
late the hospitals of this State? 

A. I think that Dr. Mayberry, in his talk before you, gave you the 
best thing that I have ever heard. 

Q. He would have a house of detention where the acute cases 
went first? 

A. Yes, sir. 

Q. And those that did not recover in three or four weeks — 

A. He said six months to a year would then be sent to the county 
or State institution, whichever was most suitable to take them. 

Q. And have the different wards graded? 

A. Yes, in fact, he would have a hospital full of acute cases and 
wherever money could do it he would prevent those acute cases be- 
coming chronic. That, I think, is in the line wit(h Providence. 

Q. If you were building a hospital where you are going to accom- 
modate five hundred patients how would you arrange that hospital, 
if you could have just what you wanted? What we want to do is to 
recommend to the Legislature the very best system and then we will 
let the Legislature say how much money they will appropriate to 
make it as near right as possible? 

A. I think I would put it on the cottage system and have it as a 
family in each cottage, say tw T enty or thirty patients, according to 
the amount you had to spend and have it run as a family; that is, 
if you had the money. It is not an economical way to do, how T ever. 

Q. What system have you here with reference to the discharge of 
patients? 

A. I discharged nearly four-fifths out on parole; that is, with their 
friends, and if they are capable of taking care of them they stay 
away and if not they come back. 

Q. What do you think of the Wisconsin system, where the acute 
are kept in State institutions and the chronic insane are kept in 
county institutions? 

A. I would want to visit Wisconsin to see how it worked. 

Q. Do you think that would be a good way in this State? 

A. Indeed I can't say that I do. 

Q. You would have all county institutions to maintain as a mini- 



344 

mum 180 patients and the maximum 500, you would have all county 
institutions of that kind? 

A. I think what we are doing here is better than I have seen 
tried elsewhere; one of the chief reasons is because it keeps the 
patients among their frieuds and there is a better opportunity for 
their friends to visit them and watch them and in so doing it may 
do the patient a great deal of good. 

Q. How often do they visit them? 

A. We have a great deal of visiting, more than I have seen at any 
other place. 

Q. In State institutions the expense is greater for friends of pa- 
tients to visit them in many instances? 

A. Yes, sir; because in many cases they are remote from their 
friends. 

Q. And it is a burden to the poor people to make such visits? 

A. Yes, sir. 

Mr. Smith. The larger the institution the more remote the patients 
are from their friends and their individuality is more liable to be 
lost. 

Q. (Mr. Thomas). How often has the Committee on Lunacy been 
here? 

A. Dr. Wetherell was here when I first come and looked around 
and has been here since three times. 

Q. Have any other members of the Board been here? 

A. Dr. McCloyd and Judge Johnson have been here and Mr. Cad 
wallader Biddle has been here once in two years and ten months. 

Q. (Mr. Snyder). How is a patient discharged from this institu- 
tion? 

A. We can discharge them ourself if a pauper case is improved 
aud we can get them with their friends. In the case of insane 
patients it is remote to write to the Lunacy Board and state the con- 
ditions and they authorize you to discharge that case, and there are 
cases where you let them go home with their friends under what is 
known as the thirty-day law, and if they get along all right under 
parole you discharge them if you think they will get well. 

Q. How long can you keep them? 

A. I asked Dr. Wetherell when he came here and he said, under 
an opinion of the Attorney General, six months. 

Q. How many have you out? 

A. About five. 

Q. How many have you discharged in that way? 

A. I think between fifty and sixty. 

Q. That law requires a certain way to have them discharged and 
committed? 



ril 




u 



A 



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345 

A. There is only one way and that is on regular commitment 
papers. 

Q. Don't you think it would be better if there would be a uniform 
law to have the commitment cases presented to the court and then 
have the court make an order? 

A. I look upon the commitment paper in Pennsylvania as not 
being a well constructed commitment paper. 

Q. Don t you think the commitment cases should be presented to 
the court and then an order made by the court? 

A. That is certainly the better way. Now we must have the cer- 
tificate of the two physicians. 

Q, I think it would deter some persons from applying if it were 
placed in the hands of the court? 

A. Those cases are very rare; I think there is one case where the 
boy was not insane. 

Q. If the court had any doubt about it they could send for the 
patient and for the people who made application? 

A. Yes, sir; I have known cases where they have been admitted 
and the court has not sanctioned it. Then there are other cases 
where there is no history. 

Q. Suppose the law was this way, that it should be done on the 
certificate of two reputable physicians and that their examinations 
should be held apart from each other? 

A. The law is something similar to that now, Senator Snyder. A 
Iiistory of the patient should also accompany the certificates of the 
physicians and that should be presented to the court and if the 
court considered, from the testimony before him, that it was a proper 
case for commitment he should make an order to have that patient 
committed; that, I think, would be an additional safeguard. 

Mr. Thomas. In cities and towns that would be all right, but in 
counties where courts only sit once in awhile how are we going to 
do that? 

Dr. Nichols. I think there ought to be regular special examiners 
for insanity patients. It is not a very pleasant duty for physicians 
to perform generally throughout the country. In Philadelphia 
there are many physicians who will not sign a commitment paper 
at all. . 

Dr. Smith. It is not a difficult thing to have a person committed 
who is not insane? 

Mr. Snyder. No, sir. 

Dr. Baker. I have a commitment paper of Massachusetts and will 
mail it to \ou. 

Mr. Garrett. The great difficulty is in getting any history from the 
patient or their friends. We know r they are insane, but cannot get 
anv historv of the case. 



346 

Dr. Baker. A case came in this morning and the paper stated that 
this patient has been acting insane for four months, that is the 
history. 

Dr. Nichols. I thought you had to give the cause on those blanks? 

Dr. Baker. But they did not do it. The first sheet of that blank 
is very good. 

Mr. Snyder. I don't think there has been any change in tine law 
with reference to our insane for many years. 

Q. What State do you think has the most advanced ideas for the 
advantage of the patient? 

A. I have not travelled around enough to say; I have only read. 

Q. How many of your patients are able to do something? 

A. About TO per cent., in wheeling dirt in wheel-barrows or pick- 
ing hair, or any employment that they can be put at to keep them 
busy. Of course that does not mean that they will do as much as 
a regular laborer in all cases. 

Q. What kind of amusements do you have here? 

A. We have pool and billiard tables, we have an organ in the ward 
and services every Sunday and in between we have entertainments 
when I can get them. 

Q. That occurs in the winter about once a month, I suppose? 

A. We can do a little better than that; last winter it averaged 
about one every two weeks. 

Q. What arrangements have you for holding religious exercises? 

A. We have a regular service, sometimes one minister and some- 
times another; we pay their expenses if they come here. We have 
services every Sunday unless the weather is very bad. I think we 
missed one service this summer. We have base ball games in which 
the patients take part. 

Q. You have all the surgical appliances and all the advantages 
of the State institutions so far as the care and treatment of the 
insane is concerned? 

A. I think we have; I think we have better than some other institu- 
tions. 

Q. (Mr. Cheney). You have no operating room here? 

A. No, sir; but if we have anything of that kind to do we make 
one. 

Q. (Mr. Snyder). Everything furnished from the farm is paid for 
the same way as if it was furnished by some one not connected with 
the farm? 

A. Yes, sir; we make a requisition. Every day we make out a state- 
ment and once a month we make this requisition and it is charged to 
our institution. My housekeeper comes down here to the steward 
once a week. Our steward is steward of both institutions and he 



347 

is also superintendent of the almshouse. We are getting our supplies 
about ten per cent, cheaper than we could buy them outside. 

Mr. Garrett. I think they get their products cheaper than they 
could buy them if they had to go out on the market. 

Q. Do you have to buy your beef? 

A. (Mr. Garrett). We buy our beef and fatten cattle, we buy steers 
and fatten them. 

Mr. Snyder. What do you pay for beef outside? 

Mr. Garrett. We kill our stock on foot and pay about six cents a 
pound. 

Mr. Snyder. At what price do you charge that to the hospital? 

Mr. Garrett. We charge them the same price that we pay for it. 

Mr. Thomas. We buy cattle on the hoof for five and six cents a 
pound and feed them here. After you kill them what do you charge 
them? 

Mr. Garrett. 8J cents. 

Mr. Snyder. That is below what you pay now? 

Mr. Thomas. Ye®, sir. 

Mr. Snyder. Contracts let to the State institutions run from nine 
to ten cents per pound and last year from seven to eight cents 
per pound for the whole carcass. At Norristown they made their 
contract at about 9J. At some of the institutions we were in they 
paid 10 cents. It is what we w T ould get if we would go into the 
butcher shop and buy for our own families. 

Dr. Baker. We do not furnish beef but once a day and for insane 
people we think this is plenty. We feed them a great many vegeta- 
bles. 

Q. Do you give your bread to your patients when it is a day old? 

A. Sometimes we do, we usually try to; they won't eat so much, 
but they like the bread when it is only a day old. 

Q. Have you anything to offer with reference to the prevention 
of insanity? 

A. The State of Connecticut has passed a law preventing the mar- 
riage of idiots and imbecibles and I think that this State should do 
something in that direction in order to prevent imbecility and in- 
sanity. 

Q. Do insane patients) act in concert in time of trouble among 
patients ? 

A. It is a very rare occurrence; I never feaw more than two and 
only two in twelve years. I go among them with one or two nurses. 

Q. If they acted in concert you would have to have fifty nurses? 

A. Yes, sir; they will assist the attendant sooner than the insane 
person. They do not think they are crazy and when there is a row 
they will assist the attendant. Having the men and women to- 



348 

gether has done a great deal of good; we have them in the dining 
room together, the women on one side and the men on the other side 
of the room. At first the men used obscene language, but now yoa 
hear nothing of the sort. 

Dr. Nichols. What do you think is needed here and what do you 
think we could add here that would be a benefit to the inmates of 
this institution as well as the people of Chester county? 

Mr. Snyder. I think you have about everything that they have 
in the State institutions except massage; in Wisconsin they have that 
treatment. You do not have that here? 

Dr. Baker. I cannot say that we have. 

Mr. Snyder. They also have the Turkish bath. 

Dr. Baker. We use a great deal of water here. 

Mr. Snyder. They have electrical boxes with electric lights where 
they put patients in with the heads out and have steam baths. 
There is one thing you need, and that is a Nurses' Home outside of 
the building. 

Dr. Nichols. We are going to have that, but where will we get 
this three or four thousand dollars more that we need in its con- 
struction. 

Mr. Snyder. It occurs to me that the idiots and imbeciles ought 
to be taken care of outside of the almshouse. Of course it would 
not benefit them because they are beyond hope, but it seems to me 
that all over the State they should be taken care of in a separate 
institution. I don't think they should be classed among the pau- 
pers. 

Mr. Thomas. We have hesitated somewhat to take up all that 
class of cases becaase we thought somebody might say, or the State 
might say, that we were pushing them in there to get that $1.50 a 
week. 

Dr. Baker. I admit it is not the best place for them and think it 
would be better to have them put in separate wards. 

Mr. Snyder. I think the criminal insane and the insane crimi- 
nal also ought to be kept in separate institutions and the epileptics 
ought to be kept separate. 

Dr. Baker. The dypsomaniacs and inebriates ought to be kept sepa- 
rate and if you have to keep them on they are most troublesome 
among the insane; they are restless and more or less vicious and 
tease and distress the other patients. 

Mr. Thomas. You discharge them as soon as you can, do you not? 

Dr. Baker. I do some, but some I have to keep because if they are 
out they will come back again. 

Mr. Cheney. Does it take long for them to recover? 

Dr. Baker. Yes, from three to thirteen weeks; then they are in a 
normal condition and the trouble starts in. 



LEGISLATIVE COMMISSION TO INQUIRE INTO THE CONDI- 
TION OF PENNSYLVANIA INSANE. 



Inspection of Matteawan (N. Y.,) 
State Hospital for Insane, 



OCTOBER 18, 1902. 



(349) 




(350) 



INSPECTION OF MATTEAWAN (N. Y.) STATE HOSPITAL FOR 
INSANE, OCTOBER 18, 1902. 



The Commission visited 1 the Matteawan State Hospital for the 
Criminal Insane on Saturdy, October 18, 1902. They were met by 
H. E. Allison, M. D., and his assistant physicians, who kindly af- 
forded them every facility possible to thoroughly review the care 
of the criminal insane. 

The Matteawan State Hospital is "for insane committed on orders 
of court of criminal jurisdiction and for persons convicted of petty 
crimes or misdemeanors not felons— becoming insane while under- 
going sentence," and is the direct outgrowth of the State asylum for 
insane crimnials at Auburn, N. Y. The Auburn hospital was estab- 
lished over 40 years ago under the management of the superintend- 
ent of prisons and under strict civil service rules, the same as all the 
other hospitals in the state of New York. 

The present asylum at Matteawan was built for the criminal and 
convict insane, and has been occupied since 1891; this was the direct 
successor to the Auburn hospital and continued to receive all 
classes of criminal and convict insane until November, 1900, at 
which time the Mt. Dannemora State Hospital for the Male Convict 
Insane was opened to relieve its overcrowded condition and to take 
all the male convict insane while undergoing sentence. This class 
of patients created much disturbance to the detriment of the other 
patients. The women convicts are still received at Matteawan as 
there are very few of them in the state (about 70). The hospital had 
about 595 inmates, with a capacity of 550 — about 70 of these were 
women, most of them committed for murders. 

It had about 120 attendants (about 1 to 4). This ratio was abso- 
lutely necessary as all the patients have to be watched very closely. 
They are practically kept the same as prisoners and have to be 
searched very often for fear of their concealing anything about their 
persons which would enable them to liberate themselves or do 
damage to others. 

They are, when first received, subjected to the same examination 
as are all criminals, photographed and measured and this record 
is filed under the proper head together with the commitment papers. 

The inmates seemed strong and more able-bodied than the usual 

(351) 



352 

classes of insane and very near all of them were able to work and 
were usually anxious to do something although the number of cures 
is very small. 

When this department of the prisons was first started over 40 
years ago it was considered to be part of the Auburn state prison 
(although under a different head or superintendent) and upon the 
same ground occupied by the prison but its management was kept en- 
tirely separate. It was found after a number of years and after the 
place became crowded and other provision would have to be made and 
that if the inmates could be given employment that they would be 
happier and better in every way. Easy work. then, as at the present 
time, is considered one of the best forms of treatment. 

The present hospital at Matteawan was built and occupied in 
ISOIj on a farm containing 250 acres. There is an administration 
building and six ward buildings connected by one story corridors, 
two infirmaries for the sick and feeble and two isolation buildings 
especially planned and constructed for the most dangerous and 
vicious class of patk-nts. The buildings are so planned so as to have 
four inner courts for exercising or airing. They are completely sur- 
rounded by the buildings and corridors so that no patients could 
escape. All the windows have heavy iron bars over them. The 
s i rctures are of brick and very substantially built and have special 
rooms for the attendants while off duty. From the character of the 
class of patients committed by the courts the doors between the 
^ards are always kept locked. 

The patients take their meals in a central dining room and are not 
allowed the use of either a knife or fork while eating. The attend- 
ants eat separately before the patients, all patients being locked 
in their rooms while the attendants are thus eating. 

The Lunacy Commission has no authority over the workings of 
Ihis hospital except the power of making suggestions, but it cannot 
enforce obedience to such suggestions as the institution is directlj 
under the State Prison Board management. 

The general system under which the Matteawan hospital is man- 
aged is explained in a letter from its medical superintendent. H. E. 
.Allison, as follows: 

"Whenever a person in confinement under indictment desires to 
oii'er the plea of insanity, he may present such plea at the time of his 
arraignment as a specification under the plea of not guilty. 

"When the defendant thus pleads insanity, the court in which the 
indictment is pending, instead of proceeding with the trial, may ap- 
point a commission of not more than three disinterested persons to 
examine him and report to the court as to his sanity at the time 
of the commission of the crime. If the defendant in confinement 



353 

under indictment appears to be at any time before or after convic- 
tion insane, the court in which the indictment is pending, unless the 
defendant is under sentence of death, may appoint a like commission 
to examine him and report to the court as to his sanity at the time 
of the examination. 

"The commission must at once proceed to make their examination. 
They must take the oath prescribed for referees, and they must be 
attended by the district attorney of the county, and may examine 
witnesses and compel their attendance. The counsel for the defense 
may take part in the proceedings. When the commissioners have 
concluded they must forthwith report the facts to the court with 
their opinion. 

"If the commission find the defendant insane, the trial and judg- 
ment must be suspended until he becomes sane, and the court, if it 
deem his discharge dangerous to the public peace or safety, must 
or<'er that he be in the meantime committed by the sheriff to a state 
lunatic asylum, and that upon his becoming sane he be redelivered 
by the superintendent of the asylum to the sheriff. 

"If the defendant be received into the asylum he must be detained 
there until he becomes sane. When he becomes sane the asylum 
must give a written notice of that fact to a judge of the supreme 
court of the district in which the asylum is situated. The judge 
must require the sheriff, without delay, to bring the defendant from 
the asylum and place him in proper custody until he be brought to 
trial, judgment, or execution, as the case may be, or be legally dis 
charged. 

"In case the question of the defendant's insanity is made an issue 
at the trial and before a jury, when the defense is insanity, the 
jury must be instructed, if they acquit him on that ground, to state 
the fact with their verdict. The court must thereupon, if the de- 
fendant be in custody, and they, the jury, deem his discharge dan- 
gerous to the public safety, order him to be committed to the State 
lunatic asylum until he becomes sane. If the jury make no state- 
ment the patient, upon his acquittal, is released. 

"If any person in confinement under indictment, or under sen- 
tence of imprisonment, or under a criminal charge, shall appear to be 
insane, the county judge is authorized to institute a careful investi- 
gation, to call two respectable physicians and other credible wit- 
nesses, to notify the district attorney to aid in the examination, 
and, if he deems it necessary, to call a jury. If it be satisfactorily 
proved that the defendant is insane, he may order his removal to a 
state lunatic asylum, where he shall remain until restored to his 
right mind. Notice of that fact is then to be given to the said 
judge and district attorney, and upon his recovery he is renian^d 

23 



354 

j prison, where criminal proceedings are resumed, or lie is other- 
wise discharged. In the event of the defendant's having been com- 
mitted to a state lunatic asylum other than the Matteawan State 
Hospital, which is a special institution erected for the criminal 
insane, the state commission in lunacy is by law authorized to trans- 
fer to the Matteawan State Hospital all patients in other hospitals 
committed thereto by courts of criminal jurisdiction. 

"If an inmate of any of the penal institutions of the state, having 
been convicted and sentenced, should become insane while under^ 
going imprisonment, the fact is certified to the warden of the prison 
by the prison physician. The warden thereupon applies to the judge 
of the district, who appoints two physicians to examine into the 
mental condition of the prisoner, and if found to be insane, such con- 
vict is, by order of the court, transferred from the prison to the 
Matteawan State Hospital. He there remains until he sihall have 
recovered. In the event of his recovery before the expiration of his 
sentence, he is returned to the custody of the prison to serve the re- 
mainder of his term. Should he not recover before the expiration of 
his sentence, and still remain insane, he is detained at the hospital 
until such time as, in 'the opinion of the medical superintendent, he 
is in condition to be released. 

"These are extracts from the insanity law and from the Code of 
Criminal Procedure. 

"In a general way, then, I would say that if a person is accused 
of crime and appears to be insane at any time during the course of 
the proceedings, either before the indictment or before his trial or 
during the trial itself, or after conviction, the rule is to examine such 
person by an order of the court, and if he is found to be insane he 
is committed to a hospital for the care of lunatics. His treatment 
there is similar to that received in any hospital for the insane. If 
the trial in the case is proceeded with and the question of insanity 
is determined by a jury and the defendant is acquitted, the jury may 
certify that the insanity which existed at the time of the commission 
of the act does or does not still continue; and, if in their opinion, 
the man is sane, he may be thereupon discharged. If, however, they 
deem his discharge dangerous to the public by reason of the con- 
tinuance of his mental disease, he may be committed to a state 
asylum. 

"Medical experts are called upon during the trial, being summoned 
by the prosecution and also by the defense, and, under the law T , any 
physician is competent to testify at the trial. In relation to the com- 
mitment of patients to an asylum, however, where such commit- 
ment depends upon the medical certificate, the physicians rendering 
such certificate must have had at least three years' practice in med- 



355 

icine; they must be registered in the office of the state commission 
in lunacy, and certificate of such registry must be filed in the office of 
the county clerk. In relation to the release of a patient from a 
state hospital, having been adjudged insane, the medical superin- 
tendent's certificate alone is now sufficient. Under the old law it 
was necessary for the medical superintendent to certify to the state 
commission in lunacy. The state commission in lunacy would then 
examine the patient and join in a certificate to a justice of the 
supreme court, who then would order his release if in his opinion 
recovery had taken place. 

"I would refer you to the insanity law, chapter 445 of the laws of 
1896, to section 454, and section 658 to 662 of the Code of Criminal 
Procedure. The law has been criticised for the reason that occa- 
sionally a person committing a homicide and acquitted on the ground 
of insanity is released without imprisonment. There has been in- 
troduced in the legislature this winter a bill which provides that 
whenever a patient shall be acquitted of a capital crime upon the 
ground of insanity, the disease shall be presumed to continue and 
he shall be committed to an asylum for the insane for a period of 
not less than ten nor more than twenty years and until he becomes 
sane. He, however, at any time during this period, may be released 
by the act of the Governor, providing it is thought proper and safe 
to order such release. 

"I herewith send you a copy of our late annual report, which will 
give you the number of convicts at this hospital found to be insane 
after sentence. Probably from 60 to 80 convicts are admitted every 
year from three great prisons of the state which contain a popula- 
tion of about 3,200 inmates. 

In the state of New York there is a special hospital for the crimi- 
nal insane which is independent of the prisons, though controlled 
by the department of prisons, and which is specially designed for 
the treatment of insane criminals. It receives patients from the 
courts during any stage of the proceedings of their trial and before 
conviction. It also receives patients after conviction, either from 
the courts or from any of the penal institutions of the state. This in- 
stitution now contains about 600 patients, and the necessity has 
arisen for its enlargement. It is now proposed to erect in connec- 
tion with one of the prisons of the state a hospital for insane con- 
victs who are under sentence, to which all persons undergoing sen- 
tence if found to be insane shall be committed, and who shall there 
be detained until recovered. This will separate the habitual crimi- 
nals who become insane from the other class of the insane who are 
not properly criminals, but whose crime is perhaps the single un- 
lawful act of their lives, and which is the result of insanitv and not 



35(5 

of criminal disposition or nature. 

This new hospital for insane convicts will be an entirely sepa- 
rate building from the prison proper, although adjacent to Clinton 
prison, one of the three great prisons of the state. It will be built 
outside of the walls of the prison on land belonging to the state, 
and is to be erected by convict labor. An appropriation of |25,000 
was made last year and the foundations are now laid. A bill appro- 
priating an additional sum of $125,000 is now pending in both 
branches of the Legislature. 

"The present hospital is located 30 miles from the nearest prison, 
and admits to its custody both convicted and unconvicted cases. 
The title of the institution is the Matteawan State Hospital. 

"I would say that Massachusetts has provided a hospital for the 
insane criminals entirely apart from the prisons. Michigan has also 
provided a similar institution, as well as the state of Illinois. Penn- 
sylvania has the subject now under consideration. In other states 
of the Union, so far as I am aware, the same method of commitment 
in general is followed, but insane patients accused of crime are sent 
to the civil hospitals for the insane." 

H. E. ALLISON, 
Medical Superintendent. 



THE LEGISLATIVE COMMISSION TO INQUIRE INTO THE 
CONDITION OF THE PENNSYLVANIA INSANE. 



Visit of the Commission to Lancas- 
ter County Hospital for the Insane 
at Lancaster, 



November 8th, 1902, 



(357) 




(368) 



VISIT OF THE COMMISSION TO LANCASTER COUNTY HOS- 
PITAL FOR THE INSANE, AT LANCASTER, NOVEMBER 8, 
1902. 



The Commission visited the Lancaster County Hospital for the 
Insane at Lancaster, on Saturday, November 8, 1902. They were 
received at the hospital by the president, H. W. Graybill, J. S. Strine, 
Fred. Shoff, J. K. Frantz, Clayton L. Nissley, J. H. Weaver, directors; 
W. S. Grubs, secretary; Wm. Good, steward; S. W. Miller, M. D., 
medical superintendent; G. L. Alexander, M. D., resident physician, 
and S. W. Kauifnian, moral instructor. The Commission inspected 
all the wards of the new and old insane hospital connected with the 
almshouse under the direction of the steward, Mr. Wm. Good and 
Drs. Miller and Alexander and the directors. 

The new hospital has been built and occupied about three years 
and has all modern conveniences such as are found in all the new 
asylums. Modern bath rooms with shower bath system installed. 
The wards are separated so that male and female patients cannot 
have any communication whatever with each other. The main stair- 
case is in the centre of the building and is made of iron and slate 
and is as near fire-proof as possible. In addition to this each ward 
has a separate stairway so that the patients can be taken to and from 
the dining room without going through the other wards. 

The hospital is a three-story brick building. It was built in this 
manner so as to conform to the general plan of the other buildings. 

The new buildings are heated by indirect radiators which is con- 
trolled by thermostats in the cellar. The air is forced through tem- 
poring coils by means of a fan to the different rooms. The dormi- 
tories are large and well lighted and ventiated, with a number of 
beds in each room. 

The old insane hospital which is connected with the new one by 
a corridor has been built and occupied by the insane for about forty 
years. Here the patients are kept in separate rooms but with the 
doors opened. At either end of each ward is a large iron grating so 
as to kv?ep the patients within limits. 

In this building all the worst class of insane are kept. Criminal 
insane and idiots along with the others. In some of the rooms 
the floors were covered with zinc but only a few such rooms are 
still in use. The authorities are changing them as rapidly as pos- 

(359) 



360 

sib le. The radiators are covered with wire so that the patients 
cannot touch them in any way. 

After making an inspection of the building the following questions 
were asked and answered: 

Q. (By Mr. Snyder, Chairman.) What number of patients have 
you? 

A.(Dr. Alexander.) 177 patients; 100 males, 77 females. 

Q. Have you any criminal insane? 

A. Yes; they are kept in the wards with the other patients. 

Q. What is the per capita cost? 

A. Last year (1901) the per capita cost was f 3.09. 

A. How often does the State Board of Charities visit your hos- 
pital? 

A. About once every three months by Dr. Wetherill and Mr. 
Biddle. 

Q. Have you any other patients at any of the State hospitals? 

A. Yes. At Harrisburg, Norristown, Wernersville and Polk. 

Q. Have you very much difficulty in having patients admitted to 
Elwyn? 

A. Can only have them admitted by exchange. We exchanged (9) 
nine last winter between 18 and 29 years of age. 

Q. Have you a physician here at all times? 

A. Yes, sir; Dr. Alexander, resident physician. 

Q. What class of patients have you at Harrisburg? 

A. Paid patients. Chronic at Wernersville. 

Q. What number of your patients are able to work? 

A. About 50 per cent. 

Q. Do you find much prejudice against having patients sent to the 
county hospital? 

A. (Dr. Miller.) Not so much now. Our experience is that out of 
50 sent to Harrisburg 44 have been returned. 

Q. What provision have you made for amusements? 

A. No regular provision whatever, although we have entertain- 
ments about once a week. 

Q. Have you any industrial or manufacturing department con- 
nected with the hospital? 

A. No. There is no industrial department connected with the 
hospital. 

Q. Do you allow any extra inducements to your patients so as to 
get them to work? 

A. Yes, sir ; we give them extra meat, etc. 

Q. How many attendants have you? 

A. Eleven. 

Q. What do you pay them? 



361 

A. Males $20.00; females $15.00 per month. 

Q. Who employs the attendants? 

A. The board of directors give the superintendent power to employ 
and discharge employes. 

Q. How are patients admitted? 

A. The same as to other hospitals. 

Q. Doctor, don't you think it would be an advantage to keep the 
different classes separate, such as the criminal insane, epileptics, 
chronics and idiots? 

A. Yes; I think they should be kept in separate wards, but in an 
institution of this kind we do not have the room. 

Q. How many acres have you? 

A. About 196 acres. 

Q. How long has this hospital been- established? 

A. The almshouse was built in 1800 and the insane have been kept 
separated for about 40 years. The new hospital has been built about 
three years. After the new building was completed a number of 
patients were taken from Harrisburg. 

Q. Have you any record of the insane as to family history? 

A. Very little. 

Q. What have been the most frequent causes of insanity? 

A. SyphiHis and alcoholism are the most frequent causes. 

Q. How is your building lighted? 

A. New building by electricity; the old one by gas. 

Q. How heated? 

A. New building by steam, indirect radiation. 

Q. Is your building fire-proof? 

A. As near fire-proof as can be. The new building is three stories 
high. 

A. It was built that way so as to conform to the other buildings. 

Q. How do you obtain your water supply? 

A. From the city. 

Q. (Mr. Bliss.) Doctor, is it your experience, after patients have 
been returned from Harrisburg that you were able to give them as 
good care here as they received at Harrisburg? 

A. They have been on a whole as well taken care of here as at 
Harrisburg. 

Q. How about epileptics and criminals? Should they be kept sep- 
arate? 

A. They should be kept separate. 

Q. Do you think you can give as good care in any county hospital 
and be as able to classify your patients as in a large State institu- 
tion? 

A. Possibly we can give as good care, certainly we try to do so and 
place the different classes in separate wards as far as is possible. 



362 

Q. Do you think if the county care system is to be continued that 
the county should have more absolute control? 

A. A number of things would have to be taken into consideration. 

Q. How are patients admitted to the hospital? 

A. Admitted by certificate, and by the Court, the same as the other 
hospitals. 

Q. How are patients discharge? 

A. The system of discharge is on 30 days parole. 

Q. What percentage of your patients are discharged as cured? 

A. Forty patients discharged as cured last year. 

Q. What number of patients admitted ? 

A. Eighty or ninety admissions with a regular population between 
170 and 190. 

Q. W T hat number of patients discharged as cured, are recommitted 
as insane? 

A. About 10 to 15 per cent returned. 

Q. Are you able to classify very much? 

A. Not very much. We have however only five criminal cases 
here. 

Q. Can you take as good care of patients as State hospitals? 

A. We think so. 

Q. What would you think of having the epileptics, criminal insane, 
idiots and imbeciles separated in different hospitals? 

A. Epileptics, criminal insane, idiots and imbeciles unquestionably 
should be separated. 



ELK COUNTY HOME 



STATEMENT 



J. W. DeHAAS, Manager, 



(363) 









(364) 



ELK COUNTY HOME. 



Statement of J. W. De Haas, Manager. 



In compliance with a request to appear before the Legislative Com- 
mission at a meeting to be held in Philadelphia for the purpose of 
obtaining a full expression of the view® of the managers and super- 
intendents of the State and county asylums upon matters pertaining 
to the welfare of their respective charges, I therefore submit the 
following statement in writing. 

My experience in the care of the insane is very limited and I hardly 
know just what to say that would lend any aid to your honorable 
board. However, I am willing to make an attempt at outlining my 
ideas as definitely as is within my power. 

In the first place I consider the county care act a very necessary 
law and one that is certainly based upon humane principles. The 
purpose of this meeting is, as I understand it, to obtain any sugges- 
tions that may be of value in ascertaining wherein the above act 
may be amended' or improved. To whom are we to look for as- 
sistance in this quest but to those gentlemen whose daily contact 
with the inmates of the above mentioned institutions has peculiarly 
fitted them for the expression of ideas pertaining to the welfare of 
their charges. 

I would like to see a county home erected, with an annex attached, 
in every county in the State of Pennsylvania. I do not wish to have 
a manager of any one of the State asylums take offense at what I 
give expression to, but I really know that the insane who are taken 
from the State asylums and placed in the county asylums improve 
more rapidly, both as to mental and physical condition, than they 
would at the State institutions, not because they do not receive 
proper treatment but because of the overcrowded condition of the 
State asylums. This overcrowding makes it almost impossible to 
classify the inmates. 

I consider it a duty of all mankind to help his fellowman, whether 
sane or insane, and not to depress or suppress, and consequently I 
say that the county homes with the insane annex is certainly a 
god-send to those poor and unfortunate creatures because the insane 
are brought back to the county from which they were taken. It 
gives their relatives an opportunity for visiting which opportunity 

(365) 



366 

is often too remote when the insane are not kept in the county home 
annex. The insane find the surroundings quieter, they find more 
liberty and the environment itself has a greater tendency toward re- 
lieving their already diseased brain. 

I can only speak from what I positively know and in order to ex- 
plain will relate an experience substantiating what has been said 
in the above. 

When we were ready to receive inmates, which was in June, 1899, 
the three county commissioners and I went to the Warren Insane 
Asylum, at Warren, Pennsylvania, and from that institution selected 
eighteen or twenty insane patients. We told them we had come to 
take them back to Elk county and the news was certainly very joyful 
for ihem. In fact their joyousness was plainly visible and even more 
so when we arrived with them at our county home. The patients 
seemed to feel that they were nearly back to their friends. From out 
of this number of insane we selected five whom we did not consider 
violent enough to justify their confinement in the annex and there- 
fore placed them in the front part of our building where the paupers 
room. Now out of these five, three were discharged as cured within 
nine months after they had been transferred from Warren asylum. 
One of this trio had been in Warren since the year 1893. The remain- 
ing two of the five referred to are still in our pauper department and 
have never given us any trouble whatever. Now this goes to show 
what a good effect a movement of this kind has on insane persons. 

Seventy-five per centum of those we placed in our annex are of 
great use to us in the way of labor. The women help in the kitchen, 
dining room and in the laundry. The men are taken out on the farm 
and the older ones do the ward work. I go over each one's partic- 
ular work with him in detail and I have found them equally as attent- 
ive and particular as men with sound minds. 

There is no doubt in my mind but that the present law governing 
the insane in the State of Pennsylvania can be improved, particularly 
that part pertaining to the county institution. 

I regard the location of an institution as of the greatest import- 
ance. I have noticed several institutions located, I might say, in 
the rural districts w r here the surroundings alone are depressing. 
In my opinion, these institutions should be located near a railroad 
and within two miles of a town or city. Having the location as 
suggested, there is an opportunity given the inmates to amuse them- 
selves by watching the trains pass by and hearing the factory whis- 
tles blow, etc. I think these things have tendency to break the 
lonesomeness which is characteristic of this class of people. 

A high elevation is also an important point in the location of these 
buildings. It gives the inmates a commanding view of the surround- 



367 

ing country. Consequently 1 consider it a wrong thing to locate 
an institution down in the hollow or low land where the inmates 
have nothing but the mountains and hills to stare at and where the 
air is certainly not so pure as it is on higher grounds. 

I believe that the insane annex built in connection with the 
county homes should be erected at some distance from the main 
building and connected therewith by a hall or corridor. I should 
also suggest the maintenance of a separate dining-room for the in- 
sane. Although we dine our insane in the same room with the 
paupers, but I do not believe this to be a good plan. I have noticed 
that the insane, as a rule, are exceedingly sensitive and somewhat 
bashful and they do not care to be stared at, especially while they 
are eating. I was instructed, after receiving our insane, to have 
them dine after the other inmates had finished their meal, but I 
found this rather troublesome owing to the fact that some of the 
old folks eat very slowly thus causing a delay in preparing the tables 
for the insane. Besides, if the insane and the other inmates w T ere 
given their meals at separate times it would be necessary to employ 
additional paid help. 

I think it would an excellent plan to have architects visit the 
county institutions and learn from the managers just what is ab- 
solutely necessary for the proper construction of these institutions. 
I would also suggest that a member of the State Board visit these 
institutions for the purpose of obtaining all the information he 
could regarding conveniences, etc., to aid in the erection of these 
buildings. It does not cost any more to erect these instiutions and 
have them convenient than it does to construct them after some 
old plan. 

I merely make these suggestions because I know most of the insti- 
tutions have been compelled to make various changes after they w T ere 
occupied. 

Another very important matter I wish to mention regarding the 
erection of insane annexes is this: Do not advocate the placing of 
the heating arrangements in the basement and supply the heat 
through the agency of registers because I have found these registers 
to be highly conducive to filthiness. The insane will not burn them- 
selves on the radiators. 

I would also advocate the painting of the walls and ceilings in- 
stead of using the common white coating for the reason that the 
latter becomes soiled and unsightly in a very short time. Also have 
plenty single rooms and see that the windows therein are well grated. 

I find a little punishment of absolute confinement has a good 
effect. I am very much in favor of large sleeping rooms. I think 
they have a better sanitary effect, besides I believe the inmates con- 



368 

trol their feelings better when together. I also think it is the best 
plan to feed the insane with good, substantial food and plenty of it. 
Keep their stomachs full for the insane are more easily controlled 
when hunger is satisfied than when they are only half fed. 

I could detail a great many more small points which would prob- 
ably be of some use but I think I have said enough. Yet, I want to 
mention one more matter, which is of vital importance, before I con- 
clude. The general meaning of the present county care act is well 
intended but rather expensive to the taxpayers. We are compelled 
by the present law to employ experienced nurses and attendants 
for our insane persons. Now we have at present but twenty-three 
or twenty-four insane and to keep the help the law requires would 
cost us nearly as much as it does to take care of sixty paupers. Now, 
the object in building our county homes was to reduce the taxation. 
Now, should the taxes increase whom do the taxpayers censure? No 
one except he county commissioners and the manager of the insti- 
tution. We can not explain to these chronic kickers that the law 
requires all this help, therefore I would suggest that the State in- 
crease our weekly allowance so that we may be able to run our insti- 
tution nearly on a level. We do not desire to make any money but 
would like to keep our heads above water. 

If I am correctly informed, the State institutions receive the same 
weekly allowance that we do ; they work large farms in connection 
with the institutions; they certainly receive a lot of help from the 
inmates; they are supplied with an army of hired help and besides 
all this receive an annual appropriation. I think that this financial 
matter should be deeply considered. 

The following is a report showing the movements of the insane 
since we opened our institution, June 8, 1889, up until the present 
time. We received forty insane; ten have been discharged as cured; 
five have been transferred to Warren ; two have died, leaving on hand 
this date nine women and fourteen men. 

I would conclude by saying that we can accommodate as many 
more as we have at the institution at present. I trust that your 
honorable board may be able to find something of interest in this 
statement. 

J. W. De Haas, 
Manager of Elk County Home, 



Somerset County Hospital for 
the Insane. 



STATEMENT OF MANAGERS 



L. C. COLBORN, Solicitor. 



(369) 

24 






^ $ is 



(870) 




r' 




SOMERSET COUNTY HOSPITAL FOR THE INSANE. 



Statement of Managers and L. C. Colborn, Solicitor. 



To the Honorable, the Legislative Commission to Investigate the 
Condition of the Insane of Pennsylvania: 

At the request of your honorable Commission the managers of 
the Somerset County Hospital for the Insane, through their attorney 
and secretary, present to you this paper embodying the views of both 
the managers of the hospital as well as the citizens of the county as 
expressed by them, and whose servants we are, together with a re- 
port of the hospital from its opening, with photographic views of 
the exterior and interior of the same. 

Civilization is the outgrowth of man's humanity, to dispel human 
ignorance and superstition, to alleviate human distress, to combat 
human error, to protect and prolong human life, is an obligation 
resting upon all, and year after year there has been a large concourse 
of noble men and women giving their time and energies to this work, 
and solve many of the problems that confront them in the adminis- 
tration of their duties. 

There is perhaps no more unfortunate form of human affliction 
than mental alienation, no more pitiable class of human dependents, 
than those who have been bereft of their reason. The weakness and 
helplessness of man in comparison with the lower order of animals 
in respect to his physical capacities has often been the theme of 
remorse and reflection. 

Without reason and his proper senses, he is the most helpless of 
beings; but with them the most powerful. By the aid of reason and' 
a cultivated and educated mind, man has acquired an ascendency 
over every kingdom of nature, and like a conqueror, he compels those 
he has subdued to enlist in his service to further and greater con- 
quests. By the aid of it he puts all nature to the question, and ob- 
tains a confession of her secret truths. He asks the beasts and they 
teach him, the fowls of the air tell him, and the fish of the sea de- 
clare unto him. He speaks to the earth and her smiling flowers, her 
golden fruits and joyous harvests reply. The mighty deep discloses 

(371!) 



372 

her secrets, at his command the stars of heaven present themselves 
to him and receive their names. He questions the regions of mid-air, 
and the rushing whirlwind and deep toned thunder give him instruc- 
tion, and he has learned to rule the dreaded lightnings with a rod 
of iron, and uses the same to serve him in nearly every vocation. 
He harnesses the mighty winds to his car and they transport him 
across the pathless ocean to the most distant lands. Xothing seems 
too great for man in the full possession of his mental faculties, aided 
by wisdom, to overcome. 

The great feats of engineering skill, the marvelous inventions and 
models of mechanism, together with the ingenuity of man, has 
brought forth the applause and admiration of the world. 

But not so with the poor and unfortunate persons who have been 
bereft of their reason and mental faculties; he is but little removed 
from the animal kingdom; he is bereft of all sense of right and 
shame, constantly planning and doing those things, which, were he 
clothed in his right mind, would be the last thing he would do, and 
be horrifying to him in the extreme. Then, indeed, should these 
unfortunate beings have our first and greatest care. The ancients 
denominated them as demons, witches and devils, and were subject 
to the most brutal and cruel treatment. 

The woes of the insane were sung by Homer and portrayed by 
Sophocles. 

Dr. Pinel, of France, was the first to devote his life to alleviating 
the sufferings of this class of diseased people. 

The cruel and barbarous treatment the insane received in the 
famous Bicetre insane prison, made his very soul stir within him, 
and through his undaunted purpose awakened an interest in these 
unfortunate beings throughout the civilized world, which was the 
beginning of the downfall of the gloomy, mad house of the past, and 
made possible the evolution of the modern hospital for the insane. 

Xor was our own country free from the same sad story of cruel 
treatment in our hospitals for the insane; and in fact, if the stories 
we sometimes hear are true we are led to believe that they are not 
altogether free from it yet. 

Our Dorothy Dix, filled with a passion to relieve the sufferings 
of this class of unfortunates, devoted her life to bring about a sys- 
tem of reform, and drove the perpetrators of the harsh measures and 
treatment out and brought about a complete reform in the care and 
treatment of these most pitiable objects. 

Christian charity was not to be shut out forever from the dark 
retreats of human torture. The dawn of the 19th century was one 
of promise for both man and humanity. The splendid achievements 
of science, the wonderful discoveries, the marvelous inventions, and 



373 

best of all the countless means for the relief and promotion of 
human suffering have made the century just closed the most notable 
epoch in the world's history since the birth of Christ. And the 
conditions and relations of human life must ultimately result in a 
permanent betterment of the race. 

Horace Man was the first to enunciate the principle that the 
dependent insane are wards of the State. And the past few years 
have witnessed the triumph of State care and developed the idea of 
home life for the treatment of the insane. 

Through the Associated Charities of Pennsylvania the movement 
of counties caring for their insane was advocated and finally adopted 
and urged by the Committee on Lunacy. Dr. Henry M. Wetherill, 
the very efficient secretary of the Committee on Lunacy, made in- 
vestigation of the various plans of caring for the insane, and from 
an elaborate report of his investigation to the Legislature our pres- 
ent law was enacted, authorizing counties to make provisions for 
the care of their insane. 

Words fail me to express to your honorable Commission my most 
hearty approval of this measure and know that it is endorsed by all 
the charitable and benevolent people of our county. 

The law is beautiful in its character, humane and statesmanlike 
in its establishment, liberal yet economical, and a saving to the 
Commonwealth. 

The criticism of some, against the county care of the insane, is 
harsh, unjust and untrue, and in several instances has come with a 
very bad grace. Pusely selfish motives that prompt it. 

The provisions of the county act for providing for their in- 
sane is becoming popular with the people, who, after all, are the best 
judges of what is right and beneficial, and so highly has it been en- 
dorsed by the people who have adopted the plan and made provision 
for the keeping of their insane under it, that within four years nine- 
teen counties of the State have gone to the expense to make the 
provisions required by law. 

Through this movement the vaults of the State Treasury may be 
closed too securely to suit many who are subsisting on large appro- 
priations from the State, and great revenues from the counties. 

Through the urgency of the Committee on Lunacy, Somerset 
county, among the first, made provisions for the care of her most 
unfortunate classes, the insane. 

The Somerset County Hospital for the Insane was opened for the 
reception of patients on the 1st day of October, 1898. The building 
was a two-story brick building, capable of accommodating forty 
patients. On the day of its opening 27 patients were admitted. 
These were quite chronic insane cases, such as is contemplated by 



374 

the act of 25th May, 1897. Arrangements were at once made to 
enlarge the building and on the 5th day of April, 1899, the Board of 
Charities approved of plans presented to them for the enlargement 
of the hospital. On the 17th day of July, 1899, the corner stone 
was laid with appropriate ceremonies, and on the 16th day of Feb- 
ruary, 1900, the building was dedicated to the care and treatment 
of the insane of Somerset county. The building or addition to the 
original 109 feet long and 48 feet wide, built of brick, slate roof, two 
stories, with finished attic, making it three stories on the inside. 
It is finished with hard wood floors and stairways, while the other 
is finished in natural wood. It is well lighted and ventilated; heated 
with hot water, and at night lighted with electric light; with w T ash 
and bath rooms on each floor. 

The male and female wards are entirely separated, all using one 
common dining room. The stories are 10 and 9 feet high, equipped 
with three stairways and four fire escapes, all easy of access by 
doors, the danger of fire being reduced to a minimum. There is a 
cellar under nearly the entire house, and those who have examined it 
pronounce it to be one of the most convenient hospitals for its size 
of any in the State. 

It is furnished with all the modern hospital furniture, iron single 
beds, with springs and good mattresses, a chair for each patient, 
beautiful dining room, cheerful hospital and sleeping rooms. 

The water is supplied from tanks in the attic, which run through 
the house. Two 50 foot hose are attached to the tanks, ready for 
use in case of fire. 

Perhaps the only thing that may be lacking in making this a 
complete and ideal hospital, is a sufficient quantity of water. In the 
summer and during dry spells the water supply is low and much 
inconvenience is suffered from it. The managers have taken steps 
to remedy this defect and have contracted for the drilling of a large 
well to which they will attach a steam pump, which will give them 
all the water necessary. 

There are also two large airing courts for the male and female 
patients, with almost an acre of ground in each, with shade trees, 
benches, swings, hammocks, and other appliances for amusement 
and exercise. The hospital has a capacity of accommodating one 
hundred patients. 

The directors of the poor are the managers of the hospital, who 
meet regularly on the 1st day of each month, while one of their 
number is designated to visit the home and hospital on the 15th 
of each month, with authority to act in all matters requiring his 
attention. 

The steward of the poor house has the full supervision of the en- 



375 

tire premises, with power to do and act in all matters for the welfare 
and good of the hospital, as well as to furnish all thing® necessary 
for the running of the home and hospital. 

In addition we have a superintendent and matron, who have the 
sole charge and superinfcendency of the hospital and patients. Two 
trained nurses, male and female, a cook and laundryman. A diet 
list has been adopted, and regular hours for the movement of the 
patients are observed. The patients when able help in many ways 
in the hospital, in cleansing the wards and other duties. 

On the 21st of March, 1900, all the insane from Somerset county 
who were in State hospitals, save two, were returned to the Somer- 
set County Hospital for the Insane. One of this number was re- 
turned to the hospital at Dixmont, simply on account of the de- 
structive tendency of the patient and his evil and wicked propensities. 

The physician is a graduate of a reputable school of medicine, 
and has been engaged in actual practice of medicine for ten years 
or more. He is in telephone communication with the hospital, be- 
sides making his regular visits. We also have a consulting physi- 
cian, who can be called in emergency, or when the severity of the 
case requires. Happily his services are rarely ever required, the 
health of the patients being excellent. 

The best evidence of the worth of the county care of its insane 
is from the patients themselves. No one desires to be returned, but 
on the other hand, the mere suggestion that they might be returned 
to State hospitals in case they grow worse or prove refractory, has 
a wholesome effect and acts as a stimulant. 

Insane have feelings, love and sympathy in their nature, even 
with a diseased mind. And when they are taken away from home, 
friends and kindred, often despondency and melancholia afflict them, 
which ends in premature death. While from actual experience and 
observation, many that have been admitted in the Somerset County 
Hospital, where friends, parents and kindred could visit them, 
encourage them, bringing with them a little dainty, make them feel 
that they are not forsaken or abandoned, but temporarily there has 
had a beneficial and wholesome effect. We frequently parole pa- 
tients for thirty days to go and see friends, and when they return it 
is like coming home; it is a pleasure and not punishment. There are 
but few incidents that speak more greatly in favor of the county 
care of these chronic insane. 

Since the opening of the Somerset County Hospital for the Insane, 
there have been admitted up to the present time, 1 May, 1902, 120 
patients; 76 males, 44 males. 

Number of patients restored, 20. 

Number of patients paroled, 15. 

Number died, 16. 



376 

Number remaining in the hospital 1st May, 1902, males, 44; fe- 
males, 28; total, 72. 

Number of patients removed.! to the State Hospital at Dixmont 
from October 1, 1898, to May 1, 1902, 3. 

The cost per capita of all inmates at the home, and patients in the 
hospital for 1899, was $1.56; 1900, $1.68; 1901, $1.84. 

, The patients in the hospital are all quiet chronic insane, such as 
was contemplated by the promoters and advocates of the act of As- 
sembly approved May 25, 1897. 

We have visited many of the hospitals of the State, have made 
personal examinations of a number, and while we make no pre- 
tensions to compare with those of the State as to furnishings, deco- 
rations and adornments, purchased at the expense of the State, yet 
we do maintain and insist most earnestly without fear of contra- 
diction, that the patients of the Somerset County Hospital for the 
Insane are as well contented, as well cared for, and as kindly treated, 
in health and in sickness as any others in any hospital in the Com- 
monwealth. 

Our people are in full accord with the idea of the county caring 
for her insane and when the proposition was suggested by Dr. Henry 
M. Wetherill, the directors of the poor were encouraged to take 
steps toward establishing a hospital, and since its opening it has 
met with universal approval, and are willing to go to most any extent 
in improving and making it an ideal and model hospital. 

We herewith submit a copy of the rules governing the home and 
hospital, in addition to the rules of the Committee on Lunacy. We 
also submit a copy of our last financial report of the home embracing 
the cost of the hospital. 

In conclusion, we would call your attention to the fact that the 
Association of the Directors of the Poor and Charities of Pennsyl- 
vania, will hold their annual convention in Somerset October 7th, 
8th and 9th, 1902, to which we most cordialy extend an invitation 
to your honorable Commission to attend, when and where you can 
visit the Somerset County Hospital for the Insane, and at the same 
time see an ideal almshouse. 

Respectfully submitted, 
Managers of Somerset County Hospital: 
W. J. GLUSSNER, 
S. J. BOWSER, 
OEO. H. SMITH. 

L. C. COLBORN, 
Solicitor and Secretary. 






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377 



Annual Financial Report of the Somerset County Poorhouse and 
Hospital for Year Ending December 31, 1901. 

Expenditures — Almshouse Expenses. 

Salaries, wages and labor (including medical attention,) |2,282 00 

Provisions and supplies, 4,002 07 

Fuel and light, 699 44 

Clothing (including shoes), 1,187 81 

Furniture and bedding and other dry goods, 738 36 

Medicine and medical supplies, 257 55 

Ordinary repairs, 138 12 

Traveling expenses, 68 56 

Farm expenses, 1,597 19 

Incidental expenses, 253 88 

Total current expenses, $11,224 98 

Buildings and improvements, 1,463 75 

Other extraordinary expenses, 613 25 

Total almshouse expenses, $13,301 98 



Outside Expenses. 

Out-door relief, $250 82 

Insane in State hospital or other hospitals, 92 34 

Children in homes and private families, 247 00 

Feeble-minded in training schools, 49 46 

Support of poor in other institutions, 72 24 

Other outside expenses, 543 37 

Aggregate expenditures, $14,556 21 

Total receipts not tax receipts, 7,979 46 

Net cost to county or district (obtained' by deducting 

receipts from the total expenses), $6,576 75 



Liabilities. 

Salaries unpaid, None. 

Number of days support given inmates, including va- 
grants, during year, 42,511 

Average weekly cost per capita, $1 84 




(378) 



Allegheny County Hospital for 
the Insane. 



STATEMENT 



OF 



J. LEWIS SRODES, M. D., Physician in Charge 



(379) 






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3£%*' 



(880) 



ALLEGHENY COUNTY HOSPITAL FOR THE INSANE. 



Statement of J. Lewis Srodes, M. D., Physician in Charge. 



Legislation Commission to Investigate the Condition of Pennsyl- 
vania Insane: 

Gentlemen: In compliance with a request from the Legislative 
Commission to Investigate the Condition of Pennsylvania Insane, 
under date of April 23, 1902, the board of directors of the Allegheny 
County Hospital for the Insane desire to submit the following: 

The Allegheny County Hospital is located in Chartiers Valley, 
at Woodville, Allegheny county, Penna., on the lines of the P., C, C. 
& St. L. and the P., C. & Y. R. R's, thirty minutes ride from Union 
depot, Pittsburg. The buildings are within ten minutes walk from 
Woodville station and stand well elevated, overlooking a considera- 
ble portion of Chartiers Valley. 

They consist of a department of the poor and a department for 
the indigent insane. The department for the insane owes its ex- 
istence to the fact that until two years ago Allegheny county was 
supporting in other institutions about 400 insane, and upon notifi- 
cation that owing to their overcrowded condition, the patients com- 
ing under their care could not be admitted. They were compelled 
to provide a place where these unfortunate cases might receive 
proper care. 

The buildings are erected on what is known as the cottage plan, 
in close proximity to the county home of Allegheny county, on a 
farm of 205 acres. There are eight cottages, two stories in height, 
each containing a day room for patients, and a dormitory for fiftv 
patients, and a corridor, on either side of which is located rooms for 
the accommodation of the disabled. 

Each cottage connects with a main corridor which is 500 feet in 
length and along which is located between the cottages, semi-circular 
day rooms and sun parlors, visiting rooms, and etc. In the cen- 
tral building is located a very commodious chapel and amusement 
room where religious services and entertainments are conducted with 
great regularity. There is also in this building a large kitchen and 
congregate dining rooms. 

(381) 



382 

The sanitary arrangements are as complete as modern methods 
can make them, each cottage having its separate toilet and bath on 
either floor. The water supply consists of filtered spring water and 
also from drilled wells which is conducted to the ward® through 
modern filters. A reserve supply is provided for by being connected 
with the mains of the Chartiers Water Company as a protection 
against fire and for sewage purposes. 

The heating of the building is accomplished by the Webster sys- 
tem, the operation of which is based on the principle of the flow of 
the steam and condensation from a pressure slightly below that of 
the atmosphere or into a partial vacuum which has been effected 
throughout the supply pipes, radiating surfaces and return pipes in 
advance of turning on the steam, which when turned on flows rapidly 
into the lower pressure. The fuel used is bituminous coal which is 
procured from a shaft in direct connection with the boiler room. 
The coal belongs to the farm as well as a liberal supply of natural gas 
from wells which are also the property of the farm. 

Our electric light plant furnishes light for the hospital and also 
for the department for the poor. 

Employment is provided for every patient whose physical con- 
dition will permit and as our building has only been occupied since 
October, 1900, we have a great variety of out door employment on 
our farm and in beautifying our lawns and etc. However, it is the 
aim and intention of the directors to provide a variety of light em- 
ployment for the winter months, such as the making of mattresses, 
brushes, baskets and such articles as will prove a useful diversion 
for the patients and be useful to the institution, and to add from 
time to time such buildings as will be necessary for the proper clas- 
sification of patients, isolation of tuberculosis and other contagious 
diseases. 

It is the unanimous opinion of our management that there should 
be erected in this State an institution for the care and treatment of 
epileptics, as the constant association of other forms of insanity 
with this class of patients is harmful and in many cases quite disas- 
trous. 

A copy of the ordinances, rules and regulations and our annual 
report in which will be found the tabulated records of our institution, 
accompany this report and will furnish the information in regard 
to the care of the patients, and the government of the officers and 
the fifty-six employes engaged at the hospital. 

October 1, 1900, building opened for the reception of patients. 

October 1, patients transferred from the Home, 110 

October 19, patients transferred from Dixmont, 50 

October 26, patients transferred from Dixmont, 50 



383 

October 31, patients transferred from Wernersville, . . 26 

November 2, Patients transferred from Dixmont, 50 

November 14, Patient® transferred from Dixmont, .... 27 

December 31, patients transferred from Home, 33 

Admitted new patients, 14 

Total received to December 31, 1900, 360 

Expenses. 

For supplies and etc., f 13,057 33 

For buildings and improvements, 8,489 52 

Total expenses, $21,546 85 

Cash received, 696 88 

Net cost to county, $20,849 97 

1901. 

Paid for supporting inmates, $37,943 99 

Received on account for patients board bill, 3,609 16 

Net cost to county and State, $33,334 83 

Number of deaths during 1901, 85 



Annual Report of the Allegheny County Hospital for the Insane. 





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In Hospital January 1, 1901, 

Admitted during- the year, 

Total in and admitted, 

Discharged during the year, 

Escaped during the year 

Died during the year 

Total during the year, 

Remaining in the Hospital December 31. 1901 



196 
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348 
113 


102 
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119 
342 


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76 


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73 



384 



Nationality of the Admitted. 





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■BLAIR COUNTY HOME AND LUNATIC HOSPITAL. 



Eeport of Directors of the Poor and Honse of Employment of Blair 
County Home and Lunatic Hospital, through the Superintendent, 
to the Court and Grand Jury in and for the said County for the 
Fiscal year ending March 31, 1900. 



To the Honorable Martin Bell, Judge of the Court of Quarter Ses- 
sions and the Grand Jury of Blair County, Pa.: 

In compliance with the act of Assembly relating to and controlling 
"boards of directors of the poor and house of employment," we 
hereby submit the following report to the honorable court and to the 
grand jury for their consideration and approyal. 

Population of the county home and lunatic hospital for the fiscal 
year commencing April 1, 1899. 

Admitted during the year, 123 adult males; 47 adult females; 12 
children, 5 of whom were born in the institution. Total admitted, 
182. 

Deaths during the year, 19; discharged, 153; total discharged, 172; 
total number cared for during the year. 331. Now we should add to 
this number the people maintained in the contagious disease hos- 
pital, which numbered in all, 21. All provisions for emergency hos- 
pita 1 were charged to the home. 



3S5 

There were also 410 meals furnished to vagrants. 
Remaining in home April 1st, 93 males, 66 females and one child. 
Total, 160. 

Farm Froduee. 

Wheat, 1,125 bushels; rye, 123 bushels; oats, 124 bushels; barley, 
2G6 bushels; corn, 18.860 bushels; fourteen acres corn ensilage; po- 
tatoes, 960 bushels; turnips, 85 bushels; peas, 22 bushels; beans, 26 
bushels; onions, 15 bushels; cucumbers, 10 bushels; lettuce, 12 bush- 
els; beets, 15 bushels; grapes, 8 bushels; sweet com, 144 dozen; toma- 
toes, 50 bushels; cabbage, 7,000 heads; peppers, 15 dozen; celery, 500 
bunches; radishes, 6 bushels; cherries, 4 bushels; apples, 600 bushels; 
corn foddier, 10 wagon loads; hay, 124 tons. 

Meats consumed in and slaughtered at the institution — 17,317 
pounds beef, 7,394 pounds pork. 295 pounds veal, 900 pounds dressed 
chickens, 176 pounds dressed turkey. 

Butter, Eggs, Soap and Applebutter — 3,240 pounds of butter, 1,049 
dozen eggs, 2,860 pounds of soap, 210 gallons applebutter. 

Sewing Room Department — 148 dresses, 96 skirts, 168 towels, lot 
infauts wear, 110 sheets, 108 aprons, 43 women's drawers, 29 night 
gowns, 33 chemises, 247 pillow cases, 36 bolsters, 8 bed ticks, 19 table 
cloths, 3 pillows, 11 shirt waists, 16 waists, 57 children's wear, 1 
qui it, 3 haps, 3 stand covers, mended 3,360 pieces, patched and darned 
360 pairs stockings. 



Inventory of Stock, Etc. 

Cattle, horses, hogs, poultry, etc., $2,174 00 

Grain andi feed on hand, 1,300 00 

Farming implements, etc., 1,026 00 

Office and chapel furniture, 169 00 

Provisions and supplies, 873 76 

Clothing, shoes and dry goods, 243 10 

Kitchen, dining room furniture and fixtures, 35S 00 

Ward furniture and furnishings, 1 698 00 

Laundry and bakery, 1,571 00 

Furniture, dishes and cutlery in steward's residence, . . 565 00 

Miscellaneous articles 350 00 

Farm mountain land, buildings, reservoirs, water line 

and electric light line, 78.500 00 



Total, $8S,827 8f 

25 



386 

Expenses for the Year 1899. 

The expenses of the directors of the poor were considerably aug- 
mented by reason of the epidemic of small-pox in Altoona and other 
places. Happily for all conecrned the matter was finally handled, 
after we had brought into use the houses at the Altoona filter beds, 
without paying exorbitant prices' for physicians and nurses. And 
while we received little or no commendation, for our work in making 
provision for these unfortunate small-pox patients, but much con- 
demnation, we are greatly pleased and reverently thankful that 
no deaths occurred at the hastily improvised contagious disease hos- 
pital, and, so far as we know, no bad effects of the disease mar the 
good looks and health of those who were afflicted. 

We did the best we could under the circumstances, making use of 
the facilities at hand. 

In consciousnesss of the disapproval of the location and kind of 
building we were compelled to occupyj hope aid and encourage- 
ment will be given toward the erection of a good contagious disease 
hospital. Let this be done if money must be secured by subscription. 
Then we will always be ready for emergencies. 

Out Door Relief. 

Strange to say that importunities for out door relief have not 
decreased, notwithstanding the fact that times are better and no 
reasonable excuse exists for unemployed men. The directors re- 
spectfully request the co-operation of all citizens in urging distressed 
people to come into the home, so that outside relief may be kept at 
a minimum. 

New Reservoir. 

The construction of a new and large reservoir, 60 feet in diameter 
and 14 feet deep, was rendered necessary because of the increased 
consumption of the institution and the smallness of the old one. 

All the building material used in its construction was hauled by 
the farm and driving teams, whir-h was done with some difficulty, 
as the grade was very steer). This reservoir has been in use for 
five months and we think it will give entire satisfaction. 

Daring the drought of the summer onr water snugly diminishes 
so much that a day's washing or bathing leaves the old reservoir dry, 
and our building and people were in emminent peril in case of fire. 
Now. however, this danger and anxiety are over and our new reser- 
voir will give us adeouate storage capacity for water for all pur- 
poses. Having been located on a high elevation, due west of the 
home, the water can be thrown upon and over the buildings by force 
of gravity, thus making the wards doubly secure from total destruc- 
tion by fire. 



387 

Expenses Imaginary; Expenses Real. 

There is on the part of many citizens of our county a misconcep- 
tion and ill-conceived criticism of the current expenses of the alms- 
house. If, as has been asserted by many persons, the cost of the 
county home for the year 1899 was the sum of twenty-six thousand 
six hundred forty-six and six one-hundredth dollars ($26,646.06), then 
why have the county auditors publish an itemized report, giving in 
detail where and to whom orders for money have been drawn? It is 
said commentary on the ability of our county auditors to prepare 
carefully and systematically what they consider all simple and 
plain reports, and yet the critics fail to comprehend the same. 

Therefore, primarily and particularly, for the benefit and satisfac- 
tion of all of our citizens who, either by misrepresentation or by 
misunderstanding, have had a wrong impression of the cost of the 
county home and have said some harsh and uncomplimentary things 
about the management, I have carefully compiled the exact expendi- 
tures of the Blair county almshouse for the year 1899, which I trans- 
mit herewith, and I hope they will have a careful and intelligent 
perusal. It is as follows: 

Salaries and wages, $4,098 50 

Provisions and supplies, 3,685 10 

Fuel and light, 1,141 37 

Clothing and shoes, .' 1,397 64 

Furniture, bedding and dry goods, 972 82 

Medicines and medical supplies, 270 43 

Ordinary repairs, 232 52 

Traveling expenses, -. 112 39 

Publishing and printing, 175 00 

Incidentals, 351 14 

Farm, 882 26 

Funeral expenses, 115 00 

Other expenses, 45 00 

Total current expenses, $16,479 17 

Buildings and improvements, 3,011 77 

Total almshouse expenses, $16,490 94 

Receipts belonging to home, 6,000 00 

Net cost of almshouse to county for the year 

1899, $10,490 94 

Number of day's support given inmates during year, . . 56,940 

Average weekly cost per capita $1 28 



388 

But the total net cost of the almshouse, to the taxpayers, for the 
year 1899, is $16,490.94 less the $3,011.77, less $6,000 cash receipts or 
$7,479.17. 

Now, take our average number of inmates, or 156 per month, and 
you have for their maintenance $47.94 per capita per year, or $4 per 
month, which is not, as many times asserted, "more than it would 
cost to keep them at a hotel." Furthermore, we have never known 
hotels to furnish clothing, food, physicians, nurses, medicines, cof- 
fins, etc., for the small pittance of $4.00 per month. 

Our cash receipts for the year were more than ever in the history 
of the almshouse, chiefly because a number of our population are 
wards of the Commonwealth as well as of the county and also for 
the reason that the Legislature of 1897 decreed that the counties 
should be helped and encouraged, and appropriated $1.50 per capita 
per week for each indigent insane person maintained in a county 
home or county asylum having accommodations and equipments ap- 
proved by the State Board of Charities. 

Money Saved the County. 

In additoin to what we received from the State Treasurer for the 
year 1899, $4,646.01, we have saved the county the sum of $6,015, 
which would have been paid our commissioners and directors of the 
poor to the several State lunatic hospitals for caring for our chronic 
insane. 

Our average number of insane maintanied in our homes was sixty- 
five (65). Ninety-one dollars would have to be paid for each one kept 
at a State hospital. 

The inception of county care in Blair county home. 

In May, 1898, we received our license from the State Board of 
Charities and recommendation to the Auditor General authorizing 
us to benefit by the "county care act" of 1897. 

On the 9th of June, 1898, we brought thirty insane patients from 
Harrisburg asylum, making with twenty-eight already in the home, 
a total of fifty-eight. 

Many of those thirty patients transferred from Harrisburg asylum 
had been here in the home preparatory to their admission into the 
State asylum, and the twenty-eight on hand were those who had 
been brought back from the asylums at Danville and Harrisburg, 
together with those gathered in and maintained in the home since 
1893. So now. at the outset, we had mostly those patients who were 
of the quiet, chronic insane, and very few recent, or acute, cases. 

The majority of these people were and are indigent, depending 
entirely upon the charity of the county. To provide properly for 
this class of patients and draw from the State $1.50 per week per 



389 

capita, it was necessary to set apart exclusively for their use cer- 
tain wards, sitting rooms and other apartments, get window guards, 
outside iron stairways and make other important changes and im- 
provements. 

Also to give these people good, wholesome food, good beds, furni- 
ture, etc. 

Also to have male and female attendant®, to care for these ner- 
vous people and kindly guard their welfare. 

This w r as all done to the satisfaction and approval of the State 
Board of Charities. The work so far has been carried forward in 
accordance with the rules and regulations of the State Committee 
on Lunacy, and our success has received the hearty commendations 
and congratulations of the honorable committee. Our average of 
those cured and improved for the year 1899 received' special mention 
and were among the highest of any in the State. Now, then, whence 
comes all this agitation and recommendations about a separate build- 
ing and proper enclosure at the almshouse? A few thousand dollars 
expended for additional dining rooms, a few isolated' rooms, a drying 
room for laundry and other necessary changes on the present build- 
ing, will meet the requirements for the quiet, chronic insane for a 
decade of years to come. 

This is all that we and our patients demand and no burden will be 
put upon our taxpayers. 

All who have carefully studded this work and kept in touch with 
the methods employed throughout the country and also the tendency 
to crowd institutions with those suffering with nervous troubles will 
agree that ultimately Blair county should have a hospital building 
for its unfortunate insane as good, fine and substantial as any other 
county in the State. Finally, let this be done, for no class of de- 
pendent people deserves more care and sympathy. But let the 
county commissioners obtain the money without burdening the peo- 
ple. If it requires a few years, let us possess our souls in patience. 

Allegheny county is spending $300,000 for an insane hospital. 
Luzerne county has just completed one at a cost of $250,000. Ches- 
ter county is now occupying its new building, which cost |120,000. 
Why should not we erect an insane hospital commensurate with the 
growth and dignity of our wonderful, resourceful and wealthy 
county. 

No other board of directors of the poor in this great State was 
able to fit up and set apart separate apartments and' wards of its 
county home for this special work with so small an outlay of money, 
because our buildings were new and so constructed that very few 
changes had to be made. The directors of the poor are not of the 
opinion that a separate building for the proper care of our insane 
is absolutely needed at the present time. 



390 

We do not have more people in the home, notwithstanding the 
nervous cases now numbering seventy-five, than we had at different 
times before getting the State license. But if the people generally 
throughout the county demand a new building and the commission- 
ers will collect the money then the directors of the poor will gladly 
co-operate. However, there is no necessity for special taxation. Let 
our honorable commissioners have time to consider and act, and re- 
trench if needs be somewhere else, and lay aside money ready for 
the building use. 

Methinks I hear the critics say extravagance! extravagance! 

Well, I am just asking you to lay aside the §6,000 a year which we 
would have to pay the State hospitals for maintaining the number 
of nervous cases we are now caring for, and add to that the $5,000 
or more which he will now T receive from the State, and in a few 
years we will have the $100,000 for the Blair county lunatic hospital. 

I know that our people are not in favor of retrogression in this 
work, but want to be classed among the first of the counties of this 
great Commonwealth in the location and construction of buildings 
and making happier the nerve-wrecked, over-worked, disappointed 
and broken-hearted men and women who make up the roll of hospital 
inmates. 

We point with pride to our magnificent court house, our ada- 
mantine jail and our beautiful county home. 

They all are monuments of the home pride and liberality of our 
people. 

Let the same broad and generous liberality be manifested in the 
establishment and erection of a hospital for the insane of our county. 
Let the building be solid, good and beautiful, an honor to our citi- 
zenship and a blessing to our unfortunate, nervous, mind-disturbed 
people. But not yet! W^e are not financially able! Let the county 
exchequer be filled, and let us consider well the location, the height, 
length and depth of a building, which will accommodate not 125, 
but probably 225 patients. 

Respectfully submitted, 

P. H. BRIDENBAUGH, 

Steward. 



INDEX. 



Page. 

Concurrent resolution, i 

Report of Commission, iii 

Report of Sub-Committee to inquire into the physical condition of build- 
ings occupied by State insane with regard to protection from fire, ... 3 

Detailed reports of — 

Pennsylvania State Lunatic Hospital, Harrisburg 4 

State Hospital for the Insane, Warren, 7 

State Institution for Feeble Minded, Polk, 10 

State Hospital for Insane, Danville, 13 

State Hospital for Insane, Norristown, 15 

State Hospital for Insane, Dixmont 19 

State Asylum for Chronic Insane, Wernersvilie, 21 

Adams County Almshouse, Gettysburg, 25 

Allegheny City Home and Hospital for the Insane, Allegheny, 27 

Allegheny County Home, Woodville, 30 

Blair County Home for the Insane, Hollidaysburg, 31 

Cumberland County Hospital for the Insane, Carlisle, 34 

Chester County Hospital for the Insane, Embreeville, 36 

Elk County Hospital for the Insane, St. Marys, 38 

Erie County Almshouse, Erie, 40 

Franklin County Almshouse, Chambersburg, 42 

Hillside Home Hospital for the Insane, Scranton, . 44 

Jefferson County Home, 46 

Central Poor District of Luzerne County Hospital for the Insane 

Retreat, 48 

Lancaster County Hospital for the Insane, Lancaster, 51 

Mercer County Hospital for the Insane, Mercer, 53 

Potter County Asylum, Coudersport, 64 

Blockley Poor House, Philadelphia, 55 

Pittsburg City Home for the Insane, Marshalsea, 57 

Somerset County Hospital for the Insane, Somerset, 62 

Washington County Home for the Insane, Arden 64 

Report of Sub-Committee to obtain the views of experienced officials 
managing the insane, 69 

Proceedings of meeting held in Philadelphia on May Gth and 7th, 1902,... 71-17i 

Inspection of — 

Blockley Hospital, Philadelphia, May 17, 1902, 175-188 

State Institution for Feeble Minded of Western Pennsylvania, at 

Polk, May 26, 1902 191-213 

State Hospital for Insane, Warren, May 26, 1902, 217-234 

Willard State Hospital for the Insane, Willard, N. Y., May 28, 1902, 237-266 
Manhattan State Hospital on Ward's Island, N. Y., June 28, 1902,... 269-270 

Norristown, July 12, 1902, 273-275 

State Asylum for the Chronic Insane, at Wernersvilie, 279-300 

County Hospital for the Insane, at Retreat, Luzerne county, Au- 
gust 9, 1902 303-318 

(391) 

1 



302 

Page. 

County Insane Hospital, in Wisconsin, 321-334 

Chester County Hospital for Insane, 337-348 

Matteawan, N. Y., Hospital for Insane, 351-356 

Lancaster County Hospital for Insane, Lancaster, 359-362 

Statement of managers — 

Elk County Home 365-368 

Somerset County Hospital for Insane 371-377 

Allegheny County Hospital for the Insane, 381-384 

Blair County Home and Lunatic Hospital, 384-390 



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